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National

Objectives
for Health
2011-2016

Department of Health
Republic of the Philippines
National Objectives for Health Philippines, 2011-2016
Health Sector Reform Agenda Monograph No. 12
July 2012

Published by the Health Policy Development and Planning Bureau (HPDPB) Department of Health
San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila 1003 Philippines
Telephone +632 651-7800.

An electronic copy of this publication can be downloaded at: www.doh.gov.ph and http://www.rchsd.ph

Articles may be reproduced in full or in part for non-profit purposes without prior permission, provided credit is given
to the DOH. A copy of the reprinted or adapted version will be appreciated.

ISSN No. 1908-6768

Suggested Citation:
2011-2016 National Objectives for Health, Health Sector Reform Agenda Monographs.
Manila, Republic of the Philippines Department of Health, 2011 (DOH HSRA Monograph No. 12)

ii
Page
Foreword v
Preface vi
Acknowledgments vii
DOH Editorial and Publication Team viii
List of Tables and Figures ix
List of Acronyms xi

INTRODUCTION 1

CHAPTER 1. THE PHILIPPINE HEALTH SYSTEM AT A GLANCE


1.1 Health Financing 3
1.2 Health Care Delivery System 5
1.3 Health Outcomes 10
1.4 Health Reform Initiatives in the Philippines 16

CHAPTER 2. KALUSUGAN PANGKALAHATAN OR UNIVERSAL HEALTH CARE

2.1 Goals of Kalusugan Pangkalahatan 18


2.2 Strategic Thrusts of Kalusugan Pangkalahatan 19
CHAPTER 3: FINANCIAL RISK PROTECTION THROUGH THE NATIONAL HEALTH INSURANCE
PROGRAM

3.1 Increasing the Coverage of NHIP 23



3.2 Increasing the Utilization of NHIP 23

3.3 Increasing the Support Value of NHIP
24
CHAPTER 4: IMPROVING ACCESS TO QUALITY HOSPITALS AND HEALTH SERVICES
4.1 Health facilities 26

4.2 Pharmaceuticals 29

4.3 Health Human Resources 32

CHAPTER 5: ATTAINING BETTER HEALTH OUTCOMES
5.1 Health-related Millennium Development Goals (MDGs)
5.1.1. MDG 1 Eradicate Extreme Poverty and Hunger. 35
5.1.2. MDG 4 Reduce Child Mortality 38
5.1.3. MDG 5 Improve Maternal Health. 42
5.1.4. MDG 6 Reverse the spread of HIV/AIDS, Malaria and other Infectious Diseases 46
5.1.5. MDG 7 Ensure Environmental Sustainability. 53

5.2 Goals for Other Diseases


5.2.1. Communicable Diseases .. 58
5.2.1.1. Diseases for Prevention and Control

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5.2.1.1.1. Soil-transmitted Helminthiasis and other Parasitoses .. 58
5.2.1.1.2. Pneumonia and other ARI . 60
5.2.1.1.3. Dengue . 61
5.2.1.1.4. Food-borne and Water-borne Diseases . 63
5.2.1.1.5. Dental and Periodontal Infections 65

5.2.1.2 Diseases for Elimination .. 67


5.2.1.2.1. Rabies. 67
5.2.1.2.2. Leprosy . 69
5.2.1.2.3. Filariasis 72
5.2.1.2.4. Schistosomiasis ... 73

5.2.1.3 Emerging and Re-emerging Infections ... 75

5.2.2. Non-Communicable Diseases


5.2.2.1. Lifestyle-Related Diseases .... 78
5.2.2.2. Diseases of the Kidney and the Urinary Tract 85
5.2.2.3. Mental Health and Mental Disorders ............ 87
5.2.2.4. Substance Abuse 89
5.2.2.5. Accidents and Injuries . 93
5.2.2.6. Blindness ... 95

5.2.3. Health Risks and Disasters


5.2.3.1. Occupational Health Risks 97
5.2.3.2. Disasters and Emergencies 98
5.2.3.3. Climate Change.. 100

5.2.4. Health of Population Groups


5.2.1.1. Adolescent and Youth .. 103
5.2.4.2. Adult Men 104
5.2.4.3. Adult Women 106
5.2.4.4. Older Persons 108

CHAPTER 6: HEALTH SUPPORT SYSTEMS


6.1. Local Health System .. 110
6.2. Health Information System 112
6.3. Internal Management Systems ... 116

CHAPTER 7: IMPLEMENTATION ARRANGEMENT FOR KALUSUGAN PANGKALAHATAN


7.1. KP Performance Target 122
7.2. Phasing of KP Implementation . 124
7.3. Cost of KP Implementation .. 127
7.4. Stewards and Partners for the KP Implementation .. 128
7.5. Coordination Mechanism for KP 132

ANNEX 1: Priority Legislative Measures

BIBLIOGRAPHY

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Inequity is a pervasive problem in our country and it is more pronounced in the health sector. Latest data show that
access to skilled providers and health facilities for birth deliveries is directly proportional to the family income. The
number of children dying is significantly higher in rural areas, among women who have no education, and among the
poorest of the poor. Previous health reforms have resulted to significant improvements in the health system. However,
we need to work more so that the most vulnerable Filipinos will experience the benefits of these reforms.

We are now pursuing the goal of Kalusugan Pangkalahatan (KP) or universal health care to overcome inequities in our
health system and deliver better health outcomes. KP represents our governments efforts to address the health needs of
the Filipinos, and particularly favors the most vulnerable segments of our population. It is built on three strategic thrusts,
namely (1) financial risk protection through expansion of the National Health Insurance Program enrollment and benefit
delivery, (2) improved hospitals, health facilities and services and (3) scaling up public health interventions to attain our
health-related Millennium Development Goals, and to control the rise of non-communicable diseases.

Through KP, around 5.2 million poorest families identified by the DSWDs National Household Targeting System were
enrolled through a full subsidy from the National Government to make them rise above the financial barriers to health
care access.

On the other hand, middle-class families that are not covered by PhilHealth may run the risk of being impoverished
when they get sick of chronic illnesses such as cancer, acute cardiac events, end-stage renal diseases and other
debilitating non-communicable diseases. The tremendous costs of these illnesses are financially and emotionally
burdensome to any family, hence the need to expand the PhilHealth coverage and benefit package to cover these groups.

There is an ongoing nationwide effort to rehabilitate and upgrade rural health units, hospitals, and all other government
health facilities, in line with KPs second strategic thrust. Our goal is to rationalize the distribution and capacities of
different health facilities to provide appropriate health services, so that the poorest families would be able to access
quality and affordable healthcare. Most of our poor go to government-run health facilities in their time of need and they
deserve no less than the best care from these public facilities.

To meet MDGs on health, we have rolled out Community Health Teams or CHTs whose primary task is to work
directly with the poorest families, assist them in determining their health needs, health services available and help them
avail of PhilHealth benefits. We are also deploying nurses to the areas with great need of their services through our
RNheals program.

The National Objectives for Health 2011-2016 sets all the health program goals, strategies, performance indicators and
targets that can lead the health sector to achieve Kalusugan Pangkalahatan by 2016. Unqualified and unwavering
commitment is critical for us to truly achieve Kalusugan Pangkalahatan, the universal health care program of the Aquino
administration. Let us all work together in realizing this common dream for all Filipinos.

ENRIQUE T. ONA, MD
Secretary of Health

v
The 2011-2016 National Objectives for Health provides guidance to all stakeholders and advocates in attaining the three
strategic goals of the Department of Health for the health sector: ensuring financial risk protection, access to quality
health facilities and attainment of the health-related Millennium Development Goals most significant of which is the
reduction in Infant and Maternal Mortality Rates and incidence of infectious diseases such as TB, HIV-AIDS, Malaria.
We also note of other emerging and reemerging diseases that call for equal attention and investment. As illnesses and
diseases are multifactorial in nature, the solutions and strategies outlined in this document go beyond clinical
interventions. All key players in the field, especially Public Health implementers and managers, should take to heart the
goals, targets and strategies outlined in this document in order to attain Kalusugan Pangkahalatan or Universal Health Care
in this country. I appeal to all heads and managers of the health system, office, or unit to take the initiative to
disseminate and educate all their constituents on the importance of achieving these health goals and targets.

Periodic review and reporting of the accomplishment of the set goals and targets shall be initiated by the Health Policy,
Finance and Research Development Cluster and shall further be cascaded to the level of the regions, provinces and
municipalities using available monitoring and evaluation tools. Our Community Health Teams should also be able to
include this vital document in their information portfolio so that all families and individuals are informed of their
important responsibility towards their health in the community. The Department of Health will continue to lead in
formulating strategic solutions to concerns identified in this document. Close collaboration with other government, non-
government, donor institutions, including the private sector shall primarily govern the actions of the Department of
Health in bringing forward the 2011-2016 National Objectives for Health.

Allow me to extend the Department of Healths recognition and great appreciation to all who in their individual and
institutional capacity have made valuable contribution in terms of their technical and expert assistance in the final
publication of this document.

MADELEINE DE ROSAS-VALERA, MD, MSCIH


Assistant Secretary
Health Policy Finance and Research Development Cluster
Department of Health

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The National Objectives for Health (NOH) 2011-2016 was developed by the Department of Health.

We gratefully acknowledge the contributions of the following institutions, offices and resource
persons in the publication of the 2011-2016 National Objectives for Health.

The following DOH programs and offices have provided their expert inputs and technical advice in
the formulation of the strategic goals and targets:

Administrative Service
Bureau of Health Devices and Technology
Bureau of Health Facilities and Services
Bureau of International Health Cooperation
Bureau of Local Health Development
Bureau of Quarantine and International Health Surveillance
Finance Service
Food and Drug Administration
Health Emergency Management Staff
Health Human Resources Development Bureau
Health Policy Development and Planning Bureau
Information Management Service
Integrity Development Committee
Internal Audit Service
Legal Service
National Center for Health Facilities Development
National Center for Disease Prevention and Control
National Center for Pharmaceutical Access and Management
National Center for Health Promotion
National Epidemiology Center
Office of the Secretary
Philippine Blood Center
Procurement Division/COBAC
Commission on Population
National Nutrition Council
Philippine Health Insurance Corporation
Philippine Institute for Traditional Alternative Health Care
Philippine National AIDS Council

Expert advice and opinions, including support for research from Donors and Partners and academic
institution:

European Union
United Nations Childrens Fund
United Nations Population Fund
Health Policy Development Program-USAID

The NOH 2011-2016 was produced with the technical assistance of Dr. John Wong, Dr. Ofelia
Alcantara and Mr. Valerie Gilbert Ulep and funded through the assistance of the World Health
Organization, Philippines.

vii
Lead Editors Dr. Lilibeth C. David
Director IV
Health Policy Development & Planning Bureau

Dr. Ma. Virginia G. Ala


Director IV
National Pharmaceutical Access and Management

Technical Editors/Writers Dr. Ma. Rosario Clarissa S. Vergeire


Ms. Rosa G. Gonzales
Dr. Elizabeth Matibag
Dr. Mar Wynn C. Bello
Ms. Frances Rose T. Elgo

Publication Assistants Ms. Madelaine Teresa T. Casimiro


Engr. Laurita R. Mendoza
Ms. Clarissa Reyes
Mr. Victor Vidal

Cover design and Lay-out Ms. Marysol Astrea Balane


Ms. Cherie May Mendoza

viii
LIST OF TABLES

Table 1. The Philippines at a Glance


Table 2. Source of Financing during Inpatient Visits, Philippines, 2008
Table 3. Distribution of out-of-pocket expenditure by component, by socio-economic status, in percent,
Philippines, 2000-2009
Table 4. Number of Beds and Rate per 1,000 Population, By Region, 2008
Table 5. Number of Government Health Workers, 2008
Table 6. Proportion of Population who Sought Inpatient Care by Facility and Selected Variables, 2008
Table 7. Projected Life Expectancy at Birth by Sex at Five Calendar-Year Intervals, 2000 to 2040
(Medium Assumption)
Table 8. Top Ten Causes of Deaths, 2009
Table 9. Child Mortality Rate, 1990-2008
Table 10. Top Ten Causes of Morbidity, 2010
Table 11. Distribution of Deaths by Cause and by Gender, 2008
Table 12. Number of RHU and BHS, 2005
Table 13. Number of Botika ng Barangay, 2005-2010
Table 14. Number of Botika ng Bayan, 2006-2010
Table 15. Distribution of Selected Health Providers according to Employment Category of Affiliation
Table 16. Number of Health Professionals in the Public Sector by Region, 2008
Table 17. Prevalence of Iron Deficiency Anemia among Different Demographic Groups, 1993-2008
Table 18. Prevalence of Vitamin A Deficiency among Different Demographic Groups, 1993-2008
Table 19. Percent Distribution of the Main Causes of Maternal Mortality, 2000 and 2005
Table 20. Health-related Practices affecting Maternal Health, 1998, 2003 and 2008
Table 21. Prevalence of Tuberculosis, 1982, 1997 and 2007
Table 22. Comparative Data on Obesity among Different Age Groups, 2008
Table 23. Prevalence of Nutritional Risks and Blood Examination Parameters related to Degenerative
Diseases, Philippines, 2008
Table 24. Per Capita Vegetables and Fruits Intake per Day, 1987, 1998 and 2003
Table 25. Prevalence of High Fasting Blood Sugar among Adults, 1993, 2003 and 2008
Table 26. Mortality Rates of Leading Cancer Sites, 2005
Table 27. Prevalence of Alcohol Beverage Drinkers in Percent, 2000 and 2010
Table 28. Distribution of Reported Cases of Drugs/ Substance Abuse by Sex and Type of Drugs/
Substance of Abuse, 2008 and 2009
Table 29. Causes of Accidents and Injuries, 2005
Table 30. Leading Causes of Death among Filipino Males Aged 25-59
Table 31. Causes of Mortality with Male Preponderance among Filipinos, 2000 and 2005
Table 32. Essential Health Care Package for Adult Male and Female
Table 33. Malignancies with Preponderance among Females Aged 25-59, 2005 and 2010
Table 34. Leading Causes of Death among Older Persons, 2005
Table 35. KP Key Performance Targets
Table 36. Total KP Requirements in Php Billion (2013-2016)

LIST OF FIGURES
Figure 1. Health Financing Flow, Philippines
Figure 2. Total Health Expenditure by Source, Philippines, 1997 and 2007
Figure 3. Number of Hospitals by Classification and Ownership, Philippines, 2009
Figure 4. Distribution of Hospitals, by Level and Geographical Distribution, Philippines, 2009
Figure 5. Crude Death Rate, 2000 and 2010
Figure 6. Infant Mortality Rate by Socio-Economic Status and Region, 2008

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Figure 7. Crude Birth Rate by Gender, 2000, 2006 and 2009
Figure 8. Total Fertility Rate by Income Quintile, 2008
Figure 9. Kalusugan Pangkalahatan Strategic Thrusts
Figure 10. Share of Medicines in the Total Out-of-Pocket, in Percent, Philippines 2000-2009
Figure 11. Trends in Malnutrition among Children, 2001, 2003 and 2008
Figure 12. Trend of Fully-Immunized Children and Children with No Vaccination, 1998, 2003 and 2008
Figure 13. Trends in Diptheria Morbidity and Mortality, 1980-2005
Figure 14. Trends in Pertussis Morbidity and Mortality, 1980-2005
Figure 15. Trends in Tetanus Neonatorum, 1995-2005
Figure 16. Trends in Measles Morbidity and Mortality, 1980-2005
Figure 17. Trends in Maternal Mortality Ratio, 1990-2006 and 2015 MDG Target
Figure 18. Percentage of Women Age 15-49 who Ever Used Contraceptive Method, 2008
Figure 19. Percentage of Women Age 15-49 who Ever Used Modern and Traditional Method, 2008
Figure 20. Number of HIV and AIDS Cases in the Philippines, 1984-2010
Figure 21. Trends in Gonorrhea and Syphilis Morbidity, 1980-2005
Figure 22. Trends in TB Case Detection Rate and Cure Rate, 2000-2008
Figure 23. Morbidity and Mortality Rate of Malaria, 1980-2005
Figure 24. Malaria Endemic Provinces, 2010
Figure 25. Trend in the Proportion of the Population with Access to Safe Drinking Water and Sanitary
Toilet Facilities in Percent, 1991-2008
Figure 26. Access to Safe Drinking Water among the Lowest 30 Percent and Highest 70 Percent Income
Class of the Population, 2008
Figure 27. Access to Sanitary Toilet Facilities among the Lowest 30 Percent and Highest 70 Percent
Income Class of the Population, 2008
Figure 28. Proportion of Population with Access to Safe Water and Sanitary Toilet by Region, 2008
Figure 29. Trends in Pneumonia Morbidity among Under-five Years Old, 1980-2005
Figure 30. Trends in Dengue Cases and Case Fatality, 2000-2010
Figure 31. Trends in Diarrhea Morbidity and Mortality, 1980-2005
Figure 32. Proportion of Orally-Fit Children (12-71 months old) by Region, 2010
Figure 33. Trends in Animal Bite Victims and Rabies Cases, 1995-2010
Figure 34. Trends in Prevalence and Case Detection Rate of Leprosy, 1986-2010
Figure 35. Leprosy Cases by Region, 2010
Figure 36. Filaria Endemic Provinces, 2010
Figure 37. Schistosomiasis Endemic Provinces, 2010
Figure 38. Mortality trends of Communicable Diseases, Malignant Neoplasm and Diseases of the Heart:
Number & Rate/100,000 Population, 1955-2005
Figure 39. Trends in Heart Disease and Diseases of the Vascular System Mortality, 1980-2005
Figure 40. Trends in the Prevalence of Hypertension, 1993-2008
Figure 41. Trends in Diabetes Mellitus Mortality per 100,000 Population, 1980-2005
Figure 42. Trends in COPD Mortality, 1980-2005
Figure 43. Trends in Cancer Morbidity and Mortality, 1980-2005
Figure 44. Trends in Kidney Disease Mortality, 1980-2005
Figure 45. Trends in Mortality Rate from Suicide and Self-Inflicted Injuries, 1980-2005
Figure 46. Trends in Mortality from Accidents and Injuries, 1980-2005
Figure 47. Types of Emergencies, 2009
Figure 48. Number of Deaths and Injured Persons due to Emergencies, 2007-2009
Figure 49. KP Interventions to Address Challenges to Universal Health Care
Figure 50. KP Implementation Road Map

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ABD Acute Bloody Diarrhea CHD Center for Health Development
ADR Adverse Drug Reaction CHED Commission on Higher Education
AHA Aquino Health Agenda CHO City Health Office
ALRTI Acute Lower Respiratory Tract Infection CHT Community Health Team
AO Administrative Order CIPH City-wide Investment Plan for Health
AOP Annual Operational Plan COBAC Central Office Bids and Awards Committee
API Annual Parasite Incidence COPD Chronic Obstructive Pulmonary Diseases
APIS Annual Poverty Incidence Survey COP Community of Practice
ARIs Acute Respiratory Infections CR Cure Rate
ART Anti-Retroviral Therapy CVD Cerebrovascular diseases
ARMM Autonomous Region for Muslim Mindanao CS Child Survival
ASEAN Association of Southeast Asian Nations DBM Department of Budget and Management
ATM Automated Teller Machine DDAPTP Dangerous Drug Abuse Prevention and
Treatment Program
BCG Bacille Calmette Guerine
DDB Dangerous Drugs Board
BDR Benefit Delivery Rate
DepED Department of Education
BLES Bureau of Labor and Employment Statistics
DHF Dengue Hemorrhagic Fever
BLHD Bureau of Local Health Development
DILG Department of the Interior and Local
BHFS Bureau of Health Facilities and Services
LIST OF ACRONYMS

Government
BHS Barangay Health Station
DM Diabetes Mellitus
BHW Barangay Health Workers
DMFP Decayed Missing and Filled Teeth
BIHC Bureau of International Health Cooperation Permanent
BnB BotikangBarangay DMFT Decayed Missing and Filled Teeth
Temporary
BNB Botikang Bayan
DOF Department of Finance
BNS Barangay Nutrition Scholar
DOH Department of Health
BMI Body Mass Index
DOLE Department of Labor and Employment
BSNOH Baseline Studies for the National Objectives
for Health DOTS Directly Observed Treatment Short-Course
CALABARZON Cavite, Laguna, Batangas, Rizal, DPs Development Partners
Quezon
DPT Diphtheria, Pertussis, Tetanus
CAR Cordillera Administrative Region
DSS Dengue Shock Syndrome
CBR Crude Birth Rate
DSWD Department of Social Welfare and
CCT Conditional Cash Transfer Development
cGMP certified Good Manufacturing Product DTR Drug Treatment and Rehabilitation
CDR Crude Death Rate DTTB Doctors to the Barrios
CEO Chief Executive Officer EA Enterprise Architecture

xi
ENGAS Electronic New Government Accounting IAPB International Agency for the Prevention of
System Blindness
EIS Executive Information System ICC Independent Chartered Cities
EO Executive Order ICT Information and Communication
Technology
EPI Expanded Program on Immunization
IDA Iron Deficiency Anemia
ESRD End-Stage Renal Disease
IDTOMIS Integrated Drug Testing Operations and
ETS Expenditure Tracking System
Management of Information System
F1 FOURmula One for Health
IEC Information Education and
FBS Fasting Blood Sugar Communication
FDA Food and Drug Administration IHBSS Integrated Health Behavioural Surveillance
System
FIES Family Income and Expenditure Survey
ILHZ Inter-Local Health Zones
FHSIS Field Health Service Information System
IMCI Integrated Management of Childhood
FNRI Food and Nutrition Research Institute Illnesses
FP Family Planning IMR Infant Mortality Rate
FPS Family Planning Survey IP Indigenous Population
4Ps Pantawid Pamilyang Pilipino Program IP-NBB Inpatient Benefit Package with No Balance
FWBD Food and Water Born Diseases Billing
GAA General Appropriations Act IPP Individually Paying Program
GATS Global Adult Tobacco Survey IRR Implementing Rules and Regulations
GDP Gross Domestic Product IS Information System
GIDA Geographically Isolated and Disadvantaged ISSP Information System Strategic Plan
Area JAC Joint Appraisal Committee
GOs Government Organizations JAPI Joint Assessment and Planning Initiative
GPPB-APCPI Government Procurement Policy KAP Knowledge, Attitude and Practices
Boards- Agency Procurement Compliance
and Performance Indicators KASAPI Kalusugan Sigurado at Abot Kaya sa
PhilHealth Insurance
GSHS Global School Health Survey
KM4HEALTH Knowledge Management for Health
GSIS Government Service Insurance System
KP Kalusugan Pangkalahatan
GYTS Global Youth Tobacco Survey
LF Lymphatic Filariasis
HEPRRP Hospital Emergency Preparedness,
Response and Rehabilitation Plan LGC Local Government Code
HH Household LGU Local Government Unit
HIM Hospital Information Management LHP Leaders for Health Program
HIS Health Information System LHS Local Health System
HIV-AIDS Human Immunodeficiency Virus / LRD Lifestyle Related Diseases
Acquired Immune Deficiency Syndrome
LRIC Local Reform Implementers Course
HMO Health Maintenance Organization
LRNCD Lifestyle related Non-Communicable
HPM Health Partners Meeting Diseases
HRH Human Resources for Health MARP Most At-Risk Population
MCH Maternal and Child Health
LIST OF ACRONYM

HSEF Health Sector Expenditure Framework


HSRA Health Sector Reform Agenda MCP Maternal and Child Package
HUC Highly Urbanized Cities MDA Mass Drug Administration

xii
MDG Millennium Development Goal NOHS National Oral Health Survey
MDR Multi-drug Resistant NNS National Nutrition Survey
MDT Multiple Drug Therapy NSRC-NIP New Born Screening Reference Center
National Institute for Health
MeTA Medicines Transparency Alliance
NSCB National Statistical Coordination Board
ME3 Monitoring and Evaluation for Equity and
Effectiveness NTP National Tuberculosis Program
MFP Modern Family Planning NTPS National TB Prevalence Survey
MFR Microfilaria Rate NSO National Statistics Office
MMDS Mortality Medical Data Systems OFC Orally Fit Children
MMR Maternal Mortality Rate OP Outpatient
MOA Memorandum of Agreement OPB Out-Patient Benefits
MTCT Mother-To-Child Transmission OPB-NBB Outpatient Benefit Package with No
Balance Billing
MTEF Medium-Term Expenditure Framework
OPIF Organizational Performance Indicator
NBB No Balance Billing
Framework
NCDPC National Center for Disease Prevention and
OPV Oral Polio Vaccine
Control
ORS Oral Rehydration Salt
NCDs Non-Communicable Diseases
PAGASA Philippine Atmospheric, Geophysical and
NCR National Capital Region
Astronomical Services Administration
NCHFD National Center for Health Facility
PCSO Philippine Charity Sweepstakes Office
Development
PEM Protein Energy Malnutrition
NCPAM National Center for Pharmaceutical Access
and Management PEP Post Exposure Prophylaxis
NDHS National Demographic and Health Survey PHAP Pharmaceutical and HealthCare Association
of the Philippines
NDHRHIS National Database on Selected Human
Resources for Health Information System PHC Primary Health Care
NEC National Epidemiology Center PHIC Philippine Health Insurance Corporation or
PhilHealth
NEDA National Economic and Development
Authority PHIS Philippine Health Information System
NG National Government PhilCAT Philippine Coalition Against TB
NGAs National Government Agencies PhilPACT Philippine Plan of Action for the Control of
Tuberculosis
NGI non Gonoccocal Infection
PHS Philippine Health Statistics
NGICS National Guidelines on Internal Control
LIST OF ACRONYMS

System PIPH Province-wide Investment Plan for Health


NGOs Non-Government Organizations PIDS Philippine Institute for Development
Studies
NHIP National Health Insurance Program
PIDSR Philippine Integrated Disease Surveillance
NHTS-PR National Household Targeting System
and Response
Poverty Reduction
PITC Philippine International Trading
NIH National Institutes of Health
Corporation
NIH-NSRC National Institute for Health -
PNAC Philippine National AIDS Council
Newborn Screening Reference Center
POMIS Procurement Operations and Management
NMEDS National Monitoring and Evaluation Dental
Information System
Survey
PNDF Philippine National Drug Formulary
NMR Neonatal Mortality Rate
PNHA Philippine National Health Accounts
NOH National Objectives for Health

xiii
PO Peoples Organization USGAO US Government Accountability Office
PPA Program Project Activity VAD Vitamin A Deficiency
PPBDC Program Planning and Budget WER Weekly Epidemiological Record
Development Committee
WHO World Health Organization
PPP Public Private Partnership
WHO-WPR World Health Organization- Western
PPAN Philippine Plan of Action for Nutrition Pacific Region
PSS Philippines Statistical System WOMB Watching Over Mothers and Babies
PSY Philippine Statistical Yearbook
PWHS Province-wide Health System
QAS Quality Assurance System
RA Republic Act
RH Reproductive Health
RHTTP Rural Health Team Placement Program
RHUs Rural Health Units
RIG Rabies Immunoglobulin
RNheals Registered Nurse for Health Enhancement
and Local Service
RPO Responsible Pet Ownership
RPOID Rehabilitation and Prevention of
Impairments and Disabilities
RTIs Respiratory Tract Infections
SCUHE Short Course for Urban Health Equity
SDAH Sector Development Approach for Health
SLA Service Level Agreement
SSESS Sentinel STI Etiologic Surveillance System
SSS Social Security System
STI Sexually Transmitted Infections
STH Soil Transmitted Helminthiasis
STTP Specialist to the Provinces
SWS Social Weather Station
SWSS Social Weather Station Survey
TACT Technical Assistance Coordination Team
TB Tuberculosis
TB CDR TB Case Detection Rate
TBD To be Determined
TCM Technical Coordination Meeting
TFR Total Fertility Rate
TRC Treatment and Rehabilitation Center
TT Tetanus Toxoid
UHC Universal Health Care
USAID United States Agency for International
Development

xiv
The Philippines is a low middle-income country located in Southeast Asia (GDP per capita: USD 2,370). It is
one of the most populous countries in the world with a population of 92.3 million as of 2010. With an annual
growth rate of 1.9 percent, the number of Filipinos is expected to reach 112 million by 2020 (National
Statistics Office). Like most emerging economies in Asia, the Philippines exhibited considerably high
economic growth with an annual average growth rate of 5 percent in the last decade (The Bangko Sentral ng
Pilipinas). The economy is expected to display strong economic performance in the medium term given the
sound macroeconomic fundamentals and robust domestic demand. Despite the significant improvements in
the domestic economy, inclusive growth remains very elusive. In 2009, 20.6 percent of the families are below
the poverty threshold which is similar to the level a decade ago (National Statistical Coordination Board,
2009). Table 1 summarizes the demographic and economic profile of the Philippines.

TABLE 1. PHILIPPINES AT A GLANCE

Indicators
Land area 300,000 sq. km.
Population (2010) (National Statistics Office) 92.3 Million
Population projection by 2020 (National Statistics Office) 111.7 Million
Population growth rate (2010) (National Statistics Office) 1.9%
Population density (2010) 796.9 per square miles
GDP per capita (2011) (The World Bank , 2011) USD 2,370
Average income (2009) (National Statistics Office, Various Years) Php206,000
Poverty incidence (2009) (The National Statistical Coordination Board) 20.6 %
Gini coefficient (National Statistical Coordination Board, 2009) 0.4881
*measures income inequality

Behind the high poverty incidence at the national level is the disparity across geographical regions and socio-
economic classes. In the National Capital Region (NCR), the poverty incidence is 2.9 percent compared to
38.1 percent of the Autonomous Region for Muslim Mindanao (ARMM) (National Statistical Coordination
INTRODUCTION
Board, 2009). The disparity of resources also reflects the high inequality in many health outcomes. In 2008,
the disparity between the poorest and richest quintiles with 40 and 15 infant deaths per 1,000 live births,
respectively, is masked by the national average of 25 infant deaths per 1,000 live births. This picture of
disparity is very common in many outcome indicators in health (National Statistics Office, 2008).

Inequalities in health outcomes can be attributed to geographical, demographic, political and socio-economic
factors. With regard to geography, the Philippines is composed of distinct geographical landscape. Hence,
delivery of health services is complex, difficult and entails innovative programs to address this gap. Many
Page | 1
localities are considered as geographically isolated and disadvantaged areas (GIDA) like remote islands and
mountainous topographies which often limit the institutionalization of sustainable health programs. The
country is also included in the Pacific ring of fire and typhoon belt which makes it susceptible to natural
calamities like earthquakes and typhoons. The Philippines experiences more than 20 typhoons annually.

The demographic feature of the country also affects the inequitable distribution of social services. Though
the country has relatively young population which increases the pool of labor force, the size is not parallel to
the available resources. Despite the slight decline in the population growth rate over the last decade, it is still
one of the highest in the Asian region. The high total fertility rate among the poor compared to the affluent
population has serious implications in health service financing and allocation.

Urbanization is also very rapid in the Philippines. More than 60 percent of the Filipinos are now living in
urban areas compared to around 30 percent 50 years ago (The World Bank , 2011). Unsurprisingly, given the
low inclusive growth and high urbanization rate, the number of urban poor especially in highly urbanized
cities is increasing. Migration from the rural parts of the country to the cities has largely contributed to
overcrowding. Moreover, there is also a high rate of migration in and out of the country (Ulep, 2012).

The delivery of health services experienced some degree of complication with the changes in the political
structure. The initial impact of devolution resulted to service fragmentation and gave challenging
opportunities for the local leadership to perform. Some local government units (LGUs) were more successful

INTRODUCTION
than others because they gave priority attention to health concerns and programs.

The constraints in health and development are not purely economic or political in nature. There are
parameters that are culturally innate such as the bahala na or complacent attitude of some Filipinos which
might explain the low adherence to beneficial health practices such as health seeking behavior (Yap and
Balboa, 2008).

Outcomes in health are therefore affected by multiple social factors. Addressing inequity in health will require
looking at these underlying factors. Most of the indicators in the succeeding chapters are disaggregated by
region, income quintile, gender and area of residence to illustrate the extent of the health inequity problem.
On the other hand, this should also guide the decision-makers and health providers in reforming the way the
health services and programs are financed, packaged and delivered.

Page | 2
THE PHILIPPINE HEALTH SYSTEM AT A GLANCE

1.1. HEALTH FINANCING

The health financing system in the country is complex as it involves different layers of financial sources,
regulatory bodies and health service providers. Figure 1 shows the financing flows for health as to sources
and uses. In general, there are four main sources of financing: (1) national and local government, (2)
insurance (government and private), (3) user fees/out of pocket and (4) donors.

FIGURE 1. HEALTH FINANCING FLOW, PHILIPPINES

Source: HSRA Monograph on Health Care Financing, Department of Health

In 1995, the National Health Insurance Program (NHIP) managed by Philippine Health Insurance
Corporation (PHIC or PhilHealth) was institutionalized and signaled the movement towards a single-payer
premium-based financing or insurance system. However, the current system continues to maintain a dual
financing system existing parallel to each other.

The total health expenditure increased from Php 87 Billion in 1995 to almost Php 225 Billion in 2007
(National Statistical Coordination Board, 2007). Although there is an increase in the total health expenditure
in nominal terms, its share on the GDP is still at 3.5 to 3.6 percent (National Statistical Coordination Board,
2007 ). Figure 2 shows the share of different health financial sources. Out of pocket has the largest share of

Page | 3
the total health expenditure. Despite the safety nets like NHIP, the share of out of pocket expenditure
increased from 47 percent in 1997 to 57 percent in 2007 (National Statistical Coordination Board, 2007 ). The
share of local and national government subsidy also decreased on the same period.

FIGURE 2. TOTAL HEALTH EXPENDITURE BY SOURCE, PHILIPPINES, 1997 AND 2007

1997 2007

Source: Philippine National Health Accounts, NSCB

The high level of out of pocket may lead to financial catastrophe and impoverishment. Table 2 validates the
large contribution of out of pocket during healthcare seeking episodes. Majority of patients from both public
and private utilize out of pocket during confinement but it is significantly higher among patients confined in
public facilities. Despite the presence of safety nets, donations (from philanthropists and charity
organizations) would still count as one of the major sources of financing (Lavado and Ulep, 2011).

TABLE 2. SOURCE OF FINANCING DURING INPATIENT VISITS, PHILIPPINES, 2008


Confined in Private Hospitals Confined in Public Facilities
Sources of Payment
(%) (%)
Salary/Income 48 51
Loan 17 23
Savings 37 32
Donation 17 23
PhilHealth 51 24
SSS/GSIS 4 2
HMO 6 1
Others 0.82 0.32
Source: Raw data from National Demographic and Health Survey, NSO 2008

Looking at the components of out-of-pocket by quintile, more than half of the medical expenditure was spent
on medicine. However, share of medicine on the total medical expenditure was consistently higher among the
poor compared to their richer counterparts. Expenditure on contraceptives was also higher among the poor
household (Lavado and Ulep, 2011).

Page | 4
TABLE 3.DISTRIBUTION OF OUT-OFPOCKET EXPENDITURE BY COMPONENTS AND BY SOCIO-
ECONOMIC STATUS, IN PERCENT, PHILIPPINES. 2000-2009

Components Poorest Richest Philippines


2000 2003 2006 2009 2000 2003 2006 2009 2000 2003 2006 2009

Medicines 74.2 75.0 73.5 74.7 59.5 59.7 59.1 57.2 67.6 66.6 66.6 65.7

Hospital Charges 1.8 2.1 2.2 2.1 7.2 6.7 6.9 7.0 4.4 4.4 4.6 4.7

Medical and Dental 6.0 5.3 5.6 6.2 19.8 18.6 18.0 16.7 12.5 12.6 11.6 11.5

Other Medical Goods 9.0 8.4 8.7 8.9 11.7 13.7 10.3 10.9 10.8 11.6 10.1 10.6

Other Medical Services 8.8 1.1 1.7 2.0 1.3 0.4 0.8 0.9 4.4 1.0 1.6 1.7

Contraceptive 0.3 8.0 7.4 5.0 0.5 0.8 1.4 2.0 0.5 3.9 3.6 3.1

Food Supplement 0.9 1.1 3.6 5.4 1.9 2.7

Source: Raw data Family Income and Expenditure Surveys, 2000-2009

1.2. HEALTH CARE DELIVERY SYSTEM


The Philippine health care system has rapidly evolved with many challenges through time. Health service
delivery was devolved to the Local Government Units (LGUs) in 1991, and for many reasons, it has not
completely surmounted the fragmentation issue. Health human resource struggles with the problems of
underemployment, scarcity and skewed distribution. There is a strong involvement of the private sector
comprising 50% of the health system but regulatory functions of the government have yet to be fully
maximized.

1.2.1. Health Facilities

Health facilities in the Philippines include government hospitals, private hospitals and primary health care
facilities. Hospitals are classified based on ownership as public or private hospitals. In the Philippines,
around 40 percent of hospitals are public (Department of Health, 2009). Out of 721 public hospitals, 70 are
managed by the DOH while the remaining hospitals are managed by LGUs and other national government
agencies (Department of Health, 2009). Both public and private hospitals can also be classified by the
service capability (see DOH AO 2005-0029). A new classification and licensing system will soon be
adopted to respond to the capacity gaps of existing health facilities in all levels. At present, Level-1
hospitals account for almost 56 percent of the total number of hospitals (Department of Health, 2009;
Lavado, 2010) which have very limited capacity, comparable only to infirmaries.

Page | 5
FIGURE 3. NUMBER OF HOSPITALS BY CLASSIFICATION
AND OWNERSHIP, PHILIPPINES, 2009
Figure 3 shows that the private
1200
70 hospitals outnumbered the government
1000
183 hospitals in all categories. The disparity
800 50
Number

38 is more noticeable in tertiary hospitals


600
405 where the number of private hospitals is
271
400
four times that of the government
200
362 417 hospitals.
0
Government Private

Level 1 Level 2 Level 3 Level 4

Source of Raw Data: List of Hospitals and Other Facilities, BHFS-DOH

Figure 4 shows the distribution of hospitals by level. Levels 1 and 2 hospitals are relatively well-distributed
across the country (though there are few provinces with limited level 2). However, hospitals with higher
service capabilities are highly concentrated in Region 3 and National Capital Region (NCR) (Lavado, 2010)

FIGURE 4. DISTRIBUTION OF HOSPITALS BY LEVEL AND GEOGRAPHICAL DISTRIBUTION,


PHILIPPINES, 2009

Level 1 Level 2 Level 3 Level 4

Source of Raw Data: List of Hospitals and Other Facilities, BHFS-DOH

The number of hospital beds is also a good indicator of health service availability. Per WHO
recommendation, there should be 20 hospital beds per 10,000 population. Table 4 describes the

Page | 6
distribution of private and public hospital beds by region. Almost all regions have insufficient beds relative
to the population except for NCR, Northern Mindanao, Southern Mindanao and CAR. Among the
seventeen regions, Autonomous Region for Muslim Mindanao (ARMM) has the lowest bed to population
ratio (0.17 beds per 1000 population), far lower than the national average.

TABLE 4. NUMBER OF BEDS AND RATE PER 1000 POPULATION BY REGION, PHILIPPINES, 2008

Region Number of beds Rate per 1000 population


Ilocos Region 4163 0.84
Cagayan Valley 2779 0.86
Central Luzon 8218 0.84
Region IV-A (CALABARZON) 9459 0.83
Region IV-B (MIMAROPA) 2093 0.73
Bicol Region 4156 0.76
Western Visayas 5714 0.78
Central Visayas 6190 0.92
Eastern Visayas 2845 0.67
Zamboanga Peninsula 2909 0.87
Northern Mindanao 4858 1.16
Southern Mindanao 4580 1.08
Central Mindanao 3680 0.94
NCR 27779 2.47
CAR 2472 1.52
ARMM 586 0.17
CARAGA 1718 0.70
Philippines 94199 1.04
Source: Department of Health

1.2.2. Health Human Resource

The health human resources are the main drivers of the health care system and are essential for the efficient
management and operation of the public health system. They are the health educators and providers of
health services. The Philippines has a huge human reservoir for health (see Table 5). However, they are
unevenly distributed in the country. Most are concentrated in urban areas such as Metro Manila and other
cities.

Page | 7
TABLE 5. NUMBER OF GOVERNMENT HEALTH WORKERS, PHILIPPINES, 2008

Number of Government Health Workers


Area
Doctors Dentists Nurses Midwives
Philippines 2838 1891 4576 17437
NCR 590 498 723 1135
CAR 89 40 131 637
I 159 105 259 1014
II 97 65 196 839
III 278 176 441 1662
IVA 238 189 472 1818
IVB 83 68 142 555
V 157 85 273 1072
VI 234 123 401 1775
VII 177 117 328 1534
VIII 155 94 201 904
IX 100 44 203 697
X 138 74 241 1052
XI 75 69 127 743
XII 113 56 194 878
ARMM 76 30 130 507
CARAGA 79 58 114 615
Source: Department of Health

1.2.3. Utilization of Health Facilities

In the 2008 National Demographic and Health Survey (NDHS), 50 percent of the clients who sought
medical advice or treatment consulted public health facilities, 42 percent went to private health facilities,
and almost 7 percent sought alternative or traditional health care. Rural Health Units (RHUs) and Barangay
Health Centers (33 percent) were the most visited health facilities in almost all the regions except for NCR
and CAR, where most of the clients visited private hospital/clinic for medical advice or treatment. The
most common reasons for seeking health care were illness or injury (68 percent), medical checkup (28
percent), dental care (2 percent), and medical requirement (1 percent) (NSO, 2008). With regard to child
delivery, more than thirty-six percent of infants are still delivered by hilots despite aggressive efforts of the
Department of Health to promote facility-based delivery (National Statistics Office, 2008).

The hospital sector in the Philippines is highly segmented in nature. Utilization of hospitals may be driven
by PhilHealth insurance coverage and socio-economic determinants as shown in Table 6. People with
PhilHealth insurance are more likely to be confined in a private hospital (56 percent), than those without
Philhealth insurance (28 percent). Similarly, patients living in urban area (52 percent) and belonging to the
richest quintile (74 percent) are also more likely to be confined in private hospitals (Lavado et al., 2010).
Page | 8
TABLE 6. PROPORTION OF POPULATION WHO SOUGHT INPATIENT CARE BY FACILITY AND SELECTED
VARIABLES, PHILIPPINES, 2008
Type of facility confined
Characteristics Category
Private hospitals (%) Public Hospitals (%) Clinics (%)
PhilHealth coverage Covered 56.0 39.6 4.4
Not covered 28.2 66.0 5.8
Urban 52.2 42.9 4.8
Type of residence
Rural 35.7 59.1 5.2
Poorest 18.9 77.3 3.7
Poorer 26.3 68.6 5.0
Wealth Quintile Middle 36.8 57.3 5.8
Richer 51.5 41.2 7.2
Richest 74.1 22.9 2.8
Source: Calculated based on the National Demographic and Health Survey, 2008

Available data shows that on the average, travel time to a health facility is 39 minutes; where travel time is
longest in ARMM (83 minutes) and shortest in NCR and Northern Mindanao, (28 minutes). Travel time is
relatively longer in rural areas (45 minutes) than in urban areas (32 minutes); and longest for persons in the
lowest wealth quintile (47 minutes) and shortest for those in the highest wealth quintile (35 minutes). Older
persons seeking care (60+ years old) have longer average travel times than younger persons (National
Statistics Office, 2008)

1.2.4. Satisfaction with Health Facilities

Based on a survey by the Social Weather Station in 2006, majority of Filipinos specifically the low income
households prefer to seek treatment in a government hospital if a family member needs confinement.
Affordability is the main reason for going to a government medical facility, while excellent service is the
main reason for going to a private medical facility (Department of Health, 2010).
The net satisfaction with services given by government hospitals has slightly improved from +30 in 2005 to
+37 in 2006. Excellent service and affordability are the main reasons for being satisfied whereas poor
service is the main reason for being dissatisfied with the services given by government hospitals (Social
Weather Stations, 2006).

Page | 9
1.3. HEALTH OUTCOMES
1.3.1. Life Expectancy

The projected average life expectancy of Filipinos in 2005 to 2010 is 68.8 years, with males having an
average life expectancy of 66.11 years and females with 71.64 years (National Statistics Office, 2010). It is
projected that the average life expectancy of Filipinos will increase to 70.38 years from 2010 to 2015 and
71.59 years from 2015 to 2020 (National Statistics Office).Table 7 provides the data on projected life
expectancy at birth.

TABLE 7.PROJECTED LIFE EXPECTANCY AT BIRTH BY SEX AT FIVE CALENDAR-YEAR INTERVALS,


PHILIPPINES, 2000 TO 2040 (MEDIUM ASSUMPTION)

Year Male Female Mean life expectancy*


2000-2005 64.11 70.14 67.62
2005-2010 66.11 71.64 68.88
2010-2015 67.61 73.14 70.38
2015-2020 68.81 74.34 71.59
2020-2025 70.01 75.54 72.77
2025-2030 71.01 76.54 73.77
2030-2035 72.01 77.54 74.77
2035-2040 73.01 78.34 75.68
Source: 2000 Census-based Population Projection
*Calculated using National Statistics Office data

1.3.2. Deaths and Births


FIGURE 5. CRUDE DEATH RATE, PHILIPPINES, 2000 AND 2010
Deaths and births are commonly
measured to determine the status of
7 2000 2010
6
deaths per 100,000 population

health and fertility dynamics of an


6 5.6
5.2
area. The crude death rate (CDR) has 4.8
5 4.4
been declining since the 1960s. 3.9
4
However, no significant change has 3
been noted since 2000-2009. The 2
number of deaths in a particular 1
population is influenced by various 0
Total Male Female
environmental factors. Global Source: National Statistics Office, 2010
experience suggests that decreasing
CDR is a result of decreasing cases of infectious diseases, improvement of perinatal practices and
innovative health interventions (National Statistics Office, 2009).

Page | 10
Seven of the ten leading causes of death are non-communicable in etiology as shown in Table 8. Cardio-
vascular diseases (i.e. diseases of the heart, and cerebrovascular diseases), cancers, chronic obstructive
pulmonary disease and diabetes are the leading non-communicable diseases. The lingering problems on
infectious diseases like pneumonia and tuberculosis are still evident as they ranked 4th and 5th leading causes
of death (National Statistics Office, 2009).

TABLE 8. TOP TEN CAUSES OF DEATHS, PHILIPPINES, 2009

Diseases Number of deaths Percentage share


Diseases of the heart 100,908 21.0
Cerebro-vascular diseases 56,670 11.8
Malignant neoplasm 47,732 9.9
Pneumonia 42,642 8.9
Tuberculosis 25,470 5.3
COPD 22,755 4.7
Diabetes 22,345 4.6
Nephritis, Nephrotic syndrome 13,799 2.9
Assault 12,227 2.5
Certain conditions arising from perinatal period 11,514 2.4
Source: National Statistics Office, 2009

Infant and maternal mortality are the most useful indicators since they reflect the general condition of the
health system. Table 9 shows the decreasing trend in Infant Mortality Rate (IMR) over the last decade. It
dropped from 57 infant deaths per 1000 live births in 1990 to 25 infant deaths per 1000 live births in 2008
(National Statistics Office, 2008). However, disaggregating IMR by socio-economic quintiles and regions
reveals performance disparities. Figure 6 shows that the IMR of the poorest quintile in 2008 is similar to
the national IMR two decades ago. Regional comparison also depicts wide variations which can be
consistently observed since early 1990s.

TABLE 9. CHILD MORTALITY RATE, PHILIPPINES, 1990-2008

Year Neonatal Mortality Infant Mortality Under-Five Mortality


1990 57.0 80.0
1993 17.7 33.6 54.2
1998 17.8 35.1 48.4
2003 17.0 29.0 40.0
2008 16.0 25.0 34.0
Source: National Demographic and Health Surveys, NSO

Page | 11
FIGURE 6. INFANT MORTALITY RATE BY SOCIO-ECONOMIC
STATUSAND REGION, PHILIPPINES, 2008

WHO defines maternal mortality as


45 40
40 death of a mother while pregnant or
35 within 42 days after delivery. Risks
Per 1,000 Live Births

29
30
24 23 attributable to pregnancy and
25
20 childbirth as well as from poor quality
15
15 health care services make this a strong
10 indicator for health care status. In
5
developing countries, hemorrhage and
0
hypertensive disorder are the major
Poorest Poorer Middle Richer Richest

causes of maternal death. Over the


Infant mortality rate by region
past decade, the decline in the
Region VIII
60

number of maternal deaths per


ARMM
100,000 live births has slowed
Region IX
50

Region XII down. Stretching as far back as


RegionVII
Infan t m ortality ra te

Region Region VIII 1993, the National Demographic


Region XI
Region II Survey (NDHS) estimated 209
40

Region V Region VI
Philippines Region
Region X Philippines Region IIIVB maternal deaths per 100,000 live
Region
RegionVII
IV Region XI
Region VII
births which significantly decreased
30

Philippines CAR
NCR to 162 in 2006 in the Family
Philippines
Region
CAR
Region III Region III
IXII Planning Survey (FPS). In 2010, the
NCR
CARAGA
20

Region
Region IVA
V
X MMR is estimated to be at 163 per
Region IX 100,000 live births and the estimate
10

from the Family Health Survey is


1993 1998 2003 2008 still to be determined.
Year
Source: National Demographic and Health Surveys, NSO

Birth rate is a common measure of fertility for a given population. Crude birth rate (CBR) indicates the
number of live births occurring during the year, per 1,000 population. Over the last decade, there is a
noticeable decline in crude birth rate for both genders (Figure 7). Crude birth rate should be analyzed in
parallel with more pertinent indictors like total fertility rate. Total fertility rate (TFR) is interpreted as the
number of births a woman would have, on average, at the end of her reproductive years (National Statistics
Office, 2008). In the Philippines, a woman is expected to have 3 births (National Statistics Office, 2008).
However, when disaggregated by socio-economic status, negative correlation is observed such that as socio-

Page | 12
economic status increases, the TFR decreases (Figure 8). On average, a woman under the poorest quintile is
likely to have 5 births while the richest quintile is only likely to have 2 births (National Statistics Office, 2008).

FIGURE 7. CRUDE BIRTH RATE BY GENDER, PHILIPPINES, 2000, 2006 AND 2009

25
Birth per 100,000 population

20

15 2000
2006
10
2009

0
Total Male Female
Source: National Statistics Office

FIGURE 8. TOTAL FERTILITY RATE BY INCOME QUINTILE, PHILIPPINES, 2008

6
Poorest, 5.2
5
Average number of births

Poor, 4.2
4
Middle, 3.2
3 Rich, 2.7

Richest, 1.9
2

0
Source: National Demographic and Health Survey 2008

Page | 13
1.3.3. Disease Trends in the Philippines

The countrys health profile depicts a distinct epidemiologic and demographic transition characterized by
double burden of diseases consisting of communicable diseases (which require major public health
intervention) and non-communicable diseases (which need expensive curative and chronic-care intervention).
This scenario makes the countrys health profile a hybrid or combination of health situations found in both
developed and developing countries. Similar to Sub-Saharan Africa, many regions in the Philippines are still
struggling to eliminate hunger and infectious diseases while continually battling on non-communicable
diseases (NCDs) as experienced in developed countries. The health status of the country therefore can be
best described to be at the crossroads of infectious and non-communicable diseases.

1.3.3.1. Communicable diseases

In the Philippines, eight out of the ten leading causes of morbidity or illness can be attributed to
infectious diseases. Illnesses related to the respiratory system such as acute respiratory infection,
pneumonia and bronchitis are the top 3 leading cause of illness as shown in Table 10.

TABLE 10.TOP TEN CAUSES OF MORBIDITY, PHILIPPINES, 2010

Rate per 100,000


Rank Disease Number
population
1 Acute Respiratory Infection 1,095,328 1203.0
2 ALRTI and Pneumonia 557,786 612.6
3 Bronchitis/Bronchiolitis 346,627 380.7
4 Hypertension 333,497 366.3
5 Acute Watery Diarrhea 322,799 354.5
6 Influenza 271,011 297.7
7 Urinary Tract Infection 82,867 91.0
8 TB Respiratory 73,614 80.9
9 Accidents 50,004 54.9
10 Injuries 35,396 38.9
Source: Field Health Services Information System, DOH

The country commits to control tuberculosis in response to the Millennium Development Goals (MDGs).
Despite the aggressive campaigns initiated by the Department of Health (DOH) in collaboration with donor
agencies, tuberculosis remains among the leading causes of morbidity and mortality in the country. HIV
control is also one of the countrys commitments to the MDGs. Though HIV prevalence of the country is
less than 1 percent, HIV cases are increasing exponentially. Endemic diseases like malaria, schistosomiasis
and filariasis are still prevalent in several regions. The country has also experienced cases of re-emerging
infectious diseases, including new and emerging diseases because of various demographic and environmental
factors.

Page | 14
1.3.3.2. Non-communicable diseases

Non-communicable diseases (NCDs) are increasing rapidly in the Philippines. In 2009, seven of the ten
leading causes of death are non-communicable in etiology. Majority of the NCDs mortality cases (i.e
cardio-vascular diseases, cancer, chronic obstructive pulmonary disease and diabetes) as shown in Table
11 are considered lifestyle-related. Around 75 percent of the total deaths can be attributed to NCDs
which is similar to the estimates in most developing countries, and 30-50 percent occurred pre-maturely
(below 60 years old) (Ulep, 2012). It is noteworthy that over-nutrition is increasing in the country while
under-nutrition remains a problem especially in rural and poor areas. Table 11 further provides data on
deaths attributed to NCDs by gender without much difference except for accidents and injuries.

TABLE 11. DISTRIBUTION OF DEATHS BY CAUSE AND BY GENDER, 2008


Total Male Female
Disease classification
Number % Number % Number %
Infectious diseases 81,821 17.73 46,465 17.29 35,356 18.34
Maternal and child health related 14,296 3.10 7,537 2.80 6,759 3.51
Ill-defined 16,010 3.47 8,048 2.99 7,962 4.13
Non-infectious in nature 349,454 75.70 206,714 76.92 142,740 74.02
CVDs 152,964 43.77 86,042 41.62 66,922 46.88
Cancer 49,047 14.04 25,341 12.26 23,706 16.61
Accidents and injuries 35,522 10.17 28,915 13.99 6,607 4.63
Diabetes 22,778 6.52 11,034 5.34 11,744 8.23
Chronic lower respiratory diseases 21,870 6.26 15,188 7.35 6,682 4.68
Chronic liver diseases and cirrhosis 6,774 1.94 5,293 2.56 1,481 1.04
Malnutrition 2,453 0.70 1,094 0.53 1,359 0.95
Mental disorder 762 0.22 579 0.28 183 0.13
Other diseases that cannot be classified
57,284 16.39 33,228 16.07 24,056 16.85
as infectious
Source: PIDS Study on NCDs, 2011, Source of data: NSO 2008

Vulnerability factors associatied with lifestyle-related diseases are also now prevalent in the country.
Around 5 percent of the population are now considered to be obese, 10 percent are diagnosed with
hypercholesterolemia and 24 percent are considered hypertensive. Moreover, most of these lifestyle
related diseases share common risk factors (i.e. unhealthy diet, smoking, sedentary lifestyle and alcohol
consumption). Over the years, there was an observable increase in the consumption of NCD implicated
food items (i.e. saturated oil, sugar and fast food), and decrease in the consumption of complex
carbohydrates like root crops and vegetables(Ulep, 2012).

Tobacco use is considered as one of the commonly shared risk factors of major NCDs like cardio-
vascular disease, certain cancers and diabetes mellitus. Smoking is also a strong risk factor of chronic
obstructive pulmonary disease and asthma. In a recent study using the 2008 NNS data, almost 31 percent
Page | 15
of the adult population are current smokers and 14 percent used tobacco in the past (Ulep, 2012).
Comparing with the GATS in 2009, the prevalence rate is almost close at 28.3%. The prevalence of
smoking is significantly higher among the poor adults. Alcohol is causally linked in varying degrees to
cancers, cardio-vascular diseases, liver disease and pancreatitis. In the country, about a quarter of the
adult populations are alcohol drinkers in 2008 (Ulep, 2012). Another study in 2009 indicates that almost
half of the alcohol drinkers are adults (Department of Health, 2009).

Health Reform Initiatives in the Philippines


Health reforms in the Philippines build upon the lessons and experiences from the past major health reform
initiatives undertaken in the last 30 years. The adoption of primary health care (PHC) approach in 1979
promoted participatory management of the local health care system. The goal was to achieve health for all
Filipinos by the year 2000. It emphasized the delivery of eight essential elements of health care, including the
prevention and control of prevalent health problems; the promotion of adequate food supply and proper
nutrition; basic sanitation and adequate supply of water; maternal and child care; immunization; prevention
and control of endemic diseases; appropriate treatment and control of common diseases; and provision of
essential drugs. To implement PHC, EO 851 was issued in 1983 integrating public health and hospital
services (World Health Organization, 2011).

The People Power Revolution strengthened the call for legitimate local representation. In early 1990s, RA
7160 or the Local Government Code (LGC) transferred the responsibility of health service provision to the
local government units. The intention of LGC was to establish a more responsive and accountable local
government structure. However, this has resulted to fragmentation of administrative control of health
services between the rural health units and hospitals and between the different levels of political structure
(World Health Organization, 2011). Prior to that, the Generics Act was adopted in 1988 to ensure adequate
supply, distribution and use of generics thereby improving access to affordable drugs and medicines.

During that time, more than half of the population had no coverage, especially the poor, the self-employed
and informal sector workers (World Health Organization, 2011). This led to the enactment of the National
Health Insurance Act of 1995 or RA 9875 which aims to provide all citizens a mechanism for financial
protection with priority given to the poor. It created the National Health Insurance Program which shall
provide health insurance coverage and ensure affordable, acceptable, available and accessible health services
for all citizens of the Philippines.
PHILIPPINE HEAL

In 1999, the health sector reform agenda was launched as a major policy framework and strategy to improve
the way health care is delivered, regulated and financed. With a battle cry of Kalusugan Para sa Masa, it was
Page | 16
designed to implement the reform package in the convergence sites. The five reform areas are: 1. public
health; 2. hospital; 3. local health systems; 4. health regulations and 5. health financing (Department of
Health, 2004). It was during this time that the DOH underwent a major organizational reform to pursue its
new role as a result of the devolution. At the local level, the municipalities were joined together to form inter-
local health zones (ILHZs) to optimize sharing of resources and maximize joint benefits from local health
initiatives.

The operational framework of health sector reforms was adopted in 2005 and was called FOURmula One for
Health (F1). The objective was to undertake critical reforms with speed, precision and effective coordination
directed at improving the efficiency, effectiveness and equity of the Philippine health system in a manner that
is felt by the Filipinos especially the poor. The F1 organized health reform initiatives into four
implementation components, namely: financing, regulation, service delivery and governance (DOHAO 2005-
0023). This time also marked the enactment of two pieces of legislation: the Universally Accessible Cheaper
and Quality Medicines Act of 2008 and the Food and Drug Administration Act of 2009.

However, despite the important progress made, successive reforms have not succeeded in adequately
addressing the persistent problem of inequity.

Page | 17
UNIVERSAL HEALTH CARE
KALUSUGAN PANGKALAHATAN

To address the remaining gaps and challenges on inequity in health, the Aquino Health Agenda (AHA),
through Administrative Order No. 2010-0036 was launched. It contains the operational strategy called
Kalusugan Pangkalahatan (KP) which aims to achieve universal health care for all Filipinos. KP seeks to ensure
equitable access to quality health care by all Filipinos beginning with those in the lowest income quintiles. KP
further fulfills President Aquinos social contract with the Filipino people, as stated in Section 7 of
Executive Order 43 series 2011:

1. Investing in our people, reducing poverty and building national competitiveness;


2. Advancing and protecting public health;
3. Building of capacities and creation of opportunities among the poor; and
4. Increasing social protection.

2.1. GOALS

The implementation of KP/Universal Health Care shall be directed towards the achievement of the health
system goals of financial risk protection, better health outcomes and responsive health system.

2.1.1. Financial Risk Protection

To protect all Filipinos, especially the poor, against the catastrophic cost of ill health, KP shall
strengthen the National Health Insurance Program (NHIP) as the prime mover in improving
financial risk protection, generating resources to modernize and sustain health facilities, and
improve the provision of public health services to achieve the Millennium Development Goals
(MDGs).

2.1.2. Responsive health system

KP aims to enhance the responsiveness of the health system and client satisfaction by improving
the quality hospitals and health care facilities. Government owned and operated hospitals and
health facilities will be upgraded to expand capacity and provide quality services to help attain
MDGs, attend to traumatic injuries and other types of emergencies, and manage non-
communicable diseases and their complications.
Page | 18
2.1.3. Better health outcomes

KP aims for the attainment of health-related MDGs by focusing on the reduction of maternal and
child mortality, morbidity and mortality from TB and malaria, and the prevalence of HIV/AIDS,
in addition to being prepared for emerging disease trends, and prevention and control of non-
communicable diseases.

2.2. STRATEGIC THRUSTS

KP shall be attained by pursuing the three strategic thrusts:

2.2.1. Financial risk protection through expansion in NHIP enrollment and benefit delivery -The
poor shall be protected from the financial impacts of health care use by:

a. Redirecting PhilHealth operations towards the improvement of the national and regional benefit
delivery;
b. Expanding enrolment of the poor in the NHIP to improve population coverage;
c. Promoting the availment of quality outpatient and inpatient services at accredited facilities
through reformed capitation and no balance billing arrangements for sponsored members,
respectively,
d. Increasing the support value of health insurance for the poor through the use of information
technology upgrades to accelerate PhilHealth claims processing, among others, and
e. A continuing study to determine the segments of the population to be covered for specific range
of services and the proportion of the total cost to be covered/ supported.
2.2.2. Improved access to quality hospitals and health care facilities It shall be achieved
through:
a. A targeted health facility enhancement program that shall leverage funds for improved facility
preparedness to adequately manage the most common causes of mortality and morbidity,
including trauma;
b. Provision of financial mechanisms drawing from public-private partnerships to support the
immediate repair, rehabilitation and construction of selected priority facilities;
c. Fiscal autonomy and income retention schemes for government hospitals and health facilities;
d. Unified and streamlined DOH licensure and PhilHealth accreditation for hospitals and facilities;
e. Regional clustering and referral networks of health facilities based on catchment areas to address
the fragmentation of services;
f. Access to quality drugs; and
g. Deployment of health professionals

2.2.3. Attainment of the health-related MDGs - This will be attained by:


a. Deploying Community Health Teams (CHTs) that shall actively assist families in assessing and
acting on their health needs;
b. Utilizing the life cycle approach in providing needed services, namely family planning; ante-natal
care; delivery in health facilities; essential newborn and immediate postpartum care; and the
Garantisadong Pambata package for children 0-14 years of age;
Page | 19
c. Aggressively promoting healthy lifestyle changes to reduce non-communicable diseases;
d. Ensuring public health measures to prevent and control communicable diseases, and adequate
surveillance and preparedness for emerging and re-emerging diseases; and
e. Harnessing the strengths of inter-agency and inter-sectoral approaches to health especially with
the Department of Education and Department of Social Welfare and the Department of Interior
and Local Government.
FIGURE 9. KALUSUGAN PANGKALAHATAN STRATEGIC THRUSTS

Achieve health-
related Millennium
Development Goal
Improve financial targets
risk protection Improve access
through to quality health
improvements in care facilities
NHIP benefit
delivery

Improved
Health
Status of
Filipinos

To implement the KP thrusts and interventions, the DOH will adopt the following general strategies:
1. Focus and engage vulnerable families, starting with provinces where most are found;
2. Partner with poverty alleviation programs like the National Household Targeting System-Poverty
Reduction (NHTS-PR) and Conditional Cash Transfer (CCT);
3. Leverage LGU participation and performance through province-wide agreements; and
4. Harness private sector participation

Focusing interventions on vulnerable families will be done by prioritizing provinces where the largest number
of families who are poor as identified by NHTS-PR and have unmet needs are located. Twelve (12) areas in
the country have been prioritized for having the most number of families who are poor and have unmet
needs. These areas are the following: Metro Manila, Negros Occidental, Quezon, Cebu, Pangasinan, Iloilo,
Cavite, Maguindanao, Zamboanga del Sur, Leyte, Davao del Sur and Pampanga. Together, these areas
account for 33 percent of NHTS-PR families and about 40 percent of unmet needs for public health services
in the country.

The concentration of the target population in these areas provides the opportunity for implementing public
health interventions at a scale that can significantly impact on national indicators. The main intervention in
reaching the families especially the CCT is through the organization and mobilization of CHTs.

Page | 20
To reach the priority and target population, the DOH will partner with the poverty alleviation programs like
the NHTS-PR and CCT for NHIP enrolment and for availing quality health services.

The DOH shall facilitate the implementation of the KP by influencing the manner by which Provinces and
component LGUs, and Cities govern local health systems. The DOH recognizes that LGUs have the primary
mandate to finance and regulate local health systems, including the provision of the right information to
families and health providers. Leveraging for LGU participation and performance will be accomplished by
entering into ARMM-wide, province-wide or city-wide agreements with LGUs. The agreements shall define
annual performance targets and resource commitments by DOH, LGUs, PHIC, development partners and
private sector. The province-wide agreements will also serve as basis for the development of CHD support
plans for LGUs that will be consolidated into the annual budget proposal of DOH.

Harnessing the private sector participation in the upgrading of public clinics and hospitals will be undertaken
by upgrading DOH retained hospitals into modern medical centers through public private partnerships
(PPP). DOH will also explore other PPP arrangements, including the outsourcing of some hospital
management services. In addition, hospital governing boards will also be organized to increase accountability
of DOH hospitals to the communities they serve. Furthermore, the private sector with the stewardship of the
public sector will be mobilized to support the public health programs that will facilitate the achievement of
the MDGs.

To facilitate the implementation of these strategies, the DOH adopted a functional management structure
that assigned accountability to CHDs and operations cluster heads in achieving health outcome targets.
Supporting the operations cluster will be the technical clusters on health financing and policy and support to
service delivery as well as the administrative and financial management clusters among others. The DOH will
relate with the DOH-ARMM directly through the Office of the Secretary, especially in the execution of the
ARMM-wide investment plan.

The success of the KP shall be measured by the progress made in preventing premature deaths, reducing
maternal and newborn deaths, controlling both communicable and non-communicable diseases,
improvements in access to quality health facilities and services and increasing NHIP coverage, benefit
utilization and support value, prioritizing the poor and the marginalized (such as the Geographically Isolated
and Disadvantaged Area (GIDA) population, indigenous population, older persons, differently-abled persons,
internally- displaced population, and people in conflict-affected areas). These performance measures are the
results of effective interaction between families and health care providers (both public and private) in local
health systems.

Page | 21
FINANCIAL RISK PROTECTION THROUGH THE NATIONAL
HEALTH INSURANCE PROGRAM
As discussed in chapter 1, the total health spending is increasing in nominal terms. However, its share in the
total Gross Domestic Product (GDP) is unchanging at 3.5 to 3.6 percent which is below the ideal 5 to 6
percent set by the WHO. In the Philippines, health spending can be accounted by different sources, namely:
national and local government subsidies, social insurance, private insurance and private out-ofpocket of
households. However, of all the different sources, out-of-pocket expenditure continues to be the main
source, accounting for 57 percent of the total health expenditure in 2007 (National Statistical Coordination
Board, 2007 ). Despite the presence of safety nets like social health insurance, out-of-pocket expenditure is
increasing rapidly. The share of social insurance is at 9-10 percent in the last ten years, while the shares of
national and local governments are noted to be decreasing (National Statistical Coordination Board, 2007 ).
Consequently, high level of out-of-pocket expenditure pushed many families into impoverishment from
catastrophic payments during health care episodes (Lavado and Ulep, 2011).

The institutionalization of social health insurance in the country through the National Health Insurance
Program (NHIP) was envisioned to reduce out-of-pocket spending, as well as the inequities in health
financing. However, growth in social health insurance expenditure relative to total health expenditure is not
enough. Though there is a noticeable increase in NHIP members over the years, effective coverage rate
remains to be low. A study revealed that there is a wide variation of NHIP coverage estimates. Household
surveys revealed that only one third of the population was covered by NHIP in 2008. Though this estimate is
contentiously low, it unmasked the existing problems on recall and membership awareness. On the other
hand, a study commissioned by USAID suggests that the coverage rate was 53 percent in 2008 (Health Policy
Development Program, 2010). In addition to problems in coverage, awareness and low benefit packages
which impact utilization, and deficiencies in health facilities, are some of the pressing issues in the Philippine
FINANCIAL RISK PROTECTION
health insurance system.

The NHIP was not able maximize its role as a safety net. As a result, the duality of health financing system
of the country continues existing parallel with other funding sources which make the system inefficient for
the government. The creation of NHIP should have signaled the country to move from tax-based financing
to premium-based insurance system. The political landscape of the country may have also hampered the
expansion of the social insurance as some political leaders have the incentive not to enroll their constituents,

Page | 22
and to patronize them through dole-outs. Unsurprisingly, donations remain to be the main source of
financing (see chapter 1). Previous disposition on the conservative use of Philhealth reserves, failed to
support the proposed benefit increase.

Given these gaps in the health insurance system, the new administration is pushing for sustainable
programmatic and policy reforms to increase the efficiency of PhilHealth as the main source of financing for
health.

3.1.Increasing the coverage

PhilHealth strategies to expand the coverage of the NHIP include mass media and advocacy programs for
LGUs to institutionalize the implementation of the Sponsored Program.

One of the main thrusts of Kalusugan Pangkalahatan is increasing financial protection and targets the NHIP as
the main source of financing. The overall goal is to maximize government and PhilHealth spending in order
to minimize out-of-pocket spending, thereby lessening the financial burden shouldered by the people. The
poorest Filipinos, as identified by the National Household Targeting System-Poverty Reduction (NHTS-PR)
list of the Department of Social Welfare and Development (DSWD), shall be targeted to gain intensified
returns for health financing. The identified poor Filipinos shall be enrolled to the NHIP and are expected to
effectively utilize health services through this projected gain of financial risk protection.

The Individually Paying Program (IPP) such as the KASAPI (Kalusugan Sigurado at Abot Kaya sa PhilHealth
Insurance) taps organized groups, such as microfinance institutions, cooperatives, non-government and civic
organizations, and various associations, to encourage bulk or group membership enrollment. By working
more seriously with informal sector organizations, PhilHealth can further augment its informal sector
membership.

3.2. Increasing utilization

Low NHIP utilization can be attributed to several factors like low benefits, lack of knowledge on healthcare
benefits, tedious administrative requirements, among others. However, one of the most important reasons is
the lack of accredited health facilities. In 2010, PhilHealth accredited 91% of private hospitals, 88% of
government hospitals and 59% of RHUs (calculated from the Philippine Health Insurance Corporation data,
2010). Decentralizing accreditation processes contributed to increased health provider accreditation, and also
as a result of new benefit packages such as the Outpatient Benefit Package, Maternity Care Package,
Newborn Care Package, and Tuberculosis Directly Observed Treatment Short course (TB DOTS).

However, inadequate health facilities remain in many rural areas. Even if they do exist, there are not enough
health personnel and appropriate drugs and medicines available. The provision of health centers to regions

Page | 23
with dismal health and socioeconomic indicators continues to be a challenge for the national government and
LGUs. Accredited hospitals remain concentrated in major regions like NCR and Region 10, and are found
scarcer in regions like CARAGA and ARMM. A similar distribution applies for accredited RHUs, TB DOTS
clinics, and other outpatient facilities. Other issues stem from deficient administrative and information
systems. There is a need to improve administrative efficiency, since claims processing still take an average of
three months.

3.3. Increasing the support value

In the Benefit Delivery Ratio study by the DOH and PhilHealth, the average support value of NHIP benefits
is only 35 percent. As one of the efforts to increase the financial protection, PhilHealth just recently
implemented the No balance billing policy for all sponsored program members who are hospitalized in
government facilities.

PhilHealth is now also shifting from fee for service to case rate system. Almost 23 case rate packages which
comprise 50 percent of the benefits are now available in institutional health care facilities accredited by
PhilHealth (Philippine Health Insurance Corporation, Various years). Among the medical cases and the
corresponding package rates are for Dengue, Pneumonia, Essential, Cerebral Infarction, Cerebro-vascular
Accident with Hemorrhage, Acute Gastroenteritis, Asthma, Typhoid Fever, and Newborn Care Package in
Hospitals and Lying-in clinics.

The following table summarizes the countrys objectives in reducing financial risk especially the poor families,
and increasing the capacity of PhilHealth to deliver healthcare benefits.

Page | 24
NATIONAL OBJECTIVES FOR HEALTH 2011-2016
OVERALL GOAL: To strengthen the NHIP as the prime mover in improving financial risk
protection, generating resources to modernize and sustain health facilities, and improve the
provision of public health services to achieve the Millennium Development Goals (MDGs).

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets


NHIP universal % National Health
PhilHealth
coverage is Insurance Program 62 (2010)
>90
achieved (NHIP) enrollment rate
Utilization of
NHIP benefits in % Accredited health
89 (2010)
an accredited facilities PhilHealth 95
facilities
increased
% Out of pocket
54.3 (2007) <50
payment from total NSCB-PNHA
Out-of-pocket health care expenditure
expenditure is PhilHealth spending as %
reduced NSCB-PNHA 9 (2007) 19
of THE
% Hospitals with NBB 100 in government
PhilHealth To Be Determined
for CCT/ NHTS families hospitals

STRATEGIES FOR 2011-2016

Universal NHIP coverage with priorities for the CCT families and the poor.
Communication and social marketing strategies to ensure that its members, especially those from
the indigent sector, are utilizing PhilHealth benefits.
Total market mobilization of all health facilities both from the public and private sector to be
NHIP accredited and providers of quality care.
Shift of payment to case payments and no balance billing especially for the indigent sector.
Improving efficiency of the PhilHealth operations to include creation of local insurance offices
and e-claims.

Page | 25
IMPROVING ACCESS TO QUALITY HOSPITALS AND HEALTH SERVICES

4.1. HEALTH FACILITIES

The Local Government Code of 1991 resulted in the devolution of health services to local government units
(LGUs) that included among others the provision, management and maintenance of government health
facilities (district hospitals, provincial hospitals, RHUs, BHS) at different levels of LGUs. Though most of
health facilities are devolved, 70 hospitals scattered all over the country are retained by the central
government (DOH retained hospitals).

Private sector plays a crucial role in the Philippine hospital system. As noted in the earlier chapter, they
account for more than 50 percent of the total number of hospitals. Almost half of the population goes to
private facilities for their health care needs. However, private hospitals cater more to the upper socio-
economic quintiles and those covered by health insurance.

In 2009, the country licensed a total of 721 public and 1,075 private hospitals. In 2010, the total hospital beds
are 98,155 (Department of Health, 2009). Of these, around half (50 percent or 49,372 beds) are in
government hospitals (National Statistics Office, 2010). To ensure provision of quality services, 10,530
facilities have been accredited (n=1835) and issued with licenses (n= 8,695) to start their operations in 2008
(Philippine Health Insurance Corporation, Various years). Issuing documents and accreditation are vital
processes in quality assurance and monitoring compliance to standards.

RHUs and BHS act as providers of public health services at the municipal and barangay levels. From 1996 to
2005, the number of RHUs was declining, and the number of BHS was stagnating. Thus, the number of
government primary care facilities cannot cope up with the increasing population.

Data has shown that the poorest of the population are the main users of government health facilities, yet
these health facilities have suffered neglect due to the inadequacy of health budgets. Lower levels of care were
bypassed even for simple primary cases because of deteriorating quality,

Page | 26
ACCESS TO QUALITY HOSPITALS AND HEALTH SERVICES
TABLE 12. NUMBER OF RHU AND BHS, lack of human resources, medical equipment and
PHILIPPINES, 2005
medicines (Department of Health, 2010). This is
Year Number of Number of particularly disadvantageous to the poor who need the
RHU BHS services the most.
1996 2856 1709
KP shall reform the health care delivery systems by
1997 2405 13096
focusing on health facility enhancement and
1998 1791 14267
rationalization and development of integrated health
1999 2121 14416
service delivery network. A functional and
2000 2218 15204 complementary network between the different
2001 1773 15107 components of local health systems should be
2002 1974 15283 formulated and implemented to properly maximize the
2003 2257 14490 health resources of each health facility. The DOH
2004 2258 15099 budget shall allocate resources in health facility
2005 2374 15436 upgrading coupled with improving the systems for
health facility operation and management. Health
Source: Department of Health
facility enhancement increase hospital revenue from
NHIP benefits and other medical and non-medical revenue and sustain the health facilities in providing
quality services especially to the poor.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Improved access to quality hospitals and health facilities by all
Filipinos, especially the poor

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets

% DOH retained hospitals


10
Access to quality upgraded/rehabilitated/cons DOH Report 95
(Upgraded 2010)
health facilities and tructed
services, especially % Provincial Hospitals
25
those commonly used upgraded/rehabilitated/cons DOH Report 95
(Upgraded 2010)
by the poor is tructed
improved % District Hospitals
30
upgraded/rehabilitated/cons DOH Report 95
(Upgraded 2010)
tructed
% RHUs
30
upgraded/rehabilitated/cons DOH Report 100
(Upgraded 2010)
tructed
% DOH-retained hospitals
Quality of inpatient
with Center of Quality or PhilHealth 17
and outpatient care is 100
Excellence Accreditation Report (May 2011)
improved
status or equivalent

Page | 27
Number of provinces and
large cities with at least one
PhilHealth 10
LGU-managed hospital with 70
Report (2010)
Center of Quality
Accreditation
% RHU/CHO with PhilHealth 59
80
PhilHealth Accreditation Report (2010)

% Government hospitals 88
PhilHealth
with PhilHealth (2010) 95
Report
Accreditation
% DOH licensed private
PhilHealth 91
hospital with PhilHealth 93
Report (2010)
Accreditation
Availability of
% Availability of essential
essential drugs and Special
drugs in health facilities at all
medicines in all levels Facility 25.3 (2010) 80
levels according to the
of government health Survey
National Drug Formulary
facilities is ensured
No. of Subnational Facilities 3
Access to specialized with specialized services for DOH Report (Upgraded/established 5
services in sub- heart, lung and kidney in 2010)
national health 3
facilities is enhanced No. of regional blood
DOH Report (Upgraded/established 9
centers
in 2010)
1
No. of Cancer centers DOH Report (Upgraded/established 3
in 2010)
Number of DOH hospital
transformed into corporate 4
Governance, DOH Report 6
hospital (2010)
sustainability and
fiscal autonomy of Number of LGU hospitals
government hospitals with fiscal autonomy or with 1
are improved DOH Report 16
scheme for economic (2010)
enterprise
Client responsiveness
of health facilities is Special
% Client Satisfaction Rate 83.2 (2010) 90
improved Survey

STRATEGIES FOR 2011-2016

A targeted health facility enhancement program that shall leverage funds for improved facility
capacity to adequately manage the most common causes of mortality and morbidity, including
trauma;
Provision of financial mechanisms drawing from public-private partnerships to support the
immediate repair, rehabilitation and construction of selected priority health facilities;
Fiscal autonomy and income retention schemes for government hospitals and health facilities;
Unified and streamlined DOH licensure and PhilHealth accreditation for hospitals and health
facilities; and
Regional clustering and referral networks of health facilities based on their catchment areas to
address the current fragmentation of health services in some regions.

Page | 28
4.2. PHARMACEUTICALS

The purpose of the regulation of essential medicines is to ensure that no Filipino dies due to problems related
to medicines. According to the World Medicines Situation, only 66% of the world population has access to
essential medicines (World Health Organization, 2004). Lack of access to medicines as well as other problems
like poor quality and irrational use, has impeded the achievement of the desired health status of the
population. Access to or effective availability of essential medicines is influenced by the kind, price, and
location of certain drugs, and also by the financing, payment, and organization of systemic actors who define
what is offered and at what terms (Roberts, 2004).

The Philippines is one of the biggest pharmaceutical markets in the ASEAN region, next to Indonesia and
Thailand. Sales of pharmaceuticals in the Philippines are estimated at Php100 billion annually, with 70 percent
being accounted for by multinational firms (Reyes, 2010). Out of total sales, 63 percent comes from a major
pharmaceutical chain, 17 percent comes from the combined sales of all other small independent pharmacies,
7 percent comes from private hospitals, 2.5 percent comes from public hospitals, 10 percent comes from
other private outlets, and 0.5 percent comes from other public outlets (Picazo, 2012).

Drugs in the Philippines are more expensive than in other countries in Asia, and it is the major source of out-
of pocket health expenditures. Analyses of various rounds of Family Income and Expenditure Surveys reveal
that almost 66 percent of total health out-of-pocket can be accounted for pharmaceutical expenditure. Figure
10 shows that the share of medicine expenditure is higher among the poorer quintiles (National Statistics
Office, Various Years).

FIGURE 10: SHARE OF MEDICINES IN THE TOTAL OUT-OF-POCKET IN PERCENT, PHILIPPINES, 2000-2009

80
70
60
50 2000
40 2003
30 2006
20 2009
10
0
Poorest Richest Philippines

Source: Family Income Expenditure Surveys

Page | 29
The catastrophic and impoverishing effects of high cost of medicines led the national government to mitigate
the drug prices. In the recent decade, different laws were enacted which aim to promote generics and increase
supply of cheaper medicines. The Generics Act (RA 6675), the Cheaper Medicines Act (RA 9502) and the
executive order requiring maximum retail prices for a number of drugs intend to improve accessibility to
affordable quality medicine.

Another landmark law is Republic Act 9711 or the Food and Drug Administration Act of 2009 which
strengthens the regulatory capacity of the DOH to ensure the quality of medicines and other health products.

The government made efforts to make drugs accessible especially in local communities by building drug
outlets known as Botika ng Baranggay and Botika ng Bayan (Table 13 and 14).

TABLE 13: NUMBER OF BOTIKA NG BARANGAY, In addition to Botika ng Barangay, Botika ng Bayan
PHILIPPINES, 2005-2010
(BNB), the flagship outlets of the Cheaper
Cumulative number of Botika ng
Year
Barangays (BnBs) Medicine Program were also established. BNB
uses franchising as way to diffuse the drug stores
2005 2977
in municipalities. The eligible applicants are
2006 7392
NGOs and cooperatives; trade and labor unions
2008 10996
or employees associations; corporate
2009 13498 foundations and religious groups; senior citizens
2010 16350 and womens groups; and sole proprietorships,
Source: PIDS study on Cheaper Medicine partnerships and corporations (Picazo, 2012).

TABLE 14: NUMBER OF BOTIKA NG BAYAN, Treatment packs for selected NCDs shall be
PHILIPPINES, 2006-2010 procured and distributed at RHUs for the use of the
Cumulative number of Botika 4Ps beneficiaries (DOH DO 2011-0188).
Year
ng Bayan (BNBs)
The irrational use of medicines is another factor
2006 1,258
that affects access to medicines. The problem
2007 1,605
stems from medicines that are inappropriately
2008 1,923 prescribed, dispensed or sold, and from patients
2009 2,195 who fail to take their medicines properly.
2010 2,256 Overutilization, misuse, or underutilization of

Source: Botikang Bayan Secretariat, PITC. medicines poses health hazards and results to
www.botikangbayan.com.ph
wastage of limited resources.

Page | 30
The DOH therefore aims to improve the safety and quality, access and availability, and rational use of
medicines and to ensure accountability and health systems support by concerned agencies.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Improve the safety and quality, access and availability, and rational use
of medicines and ensure accountability and health systems support by concerned

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objectives
% Population with
Access and DOH Program
access to affordable 73 (2009) 95
availability of Report
essential drugs
medicines is
% market share of
improved PHAP 40% (2009) >65%
generics
% Incidence of
45*
counterfeit FDA 24**
(Jan to Nov 2009)
medicines
% Drug
Safety and
manufacturing FDA 20 for cGMP
quality is 100
facilities with (2009)
improved
quality seal
Number of ADRs 3,866 reported
reported per 1 FDA ADRs (Jan-Nov To be determined
million population 2009)
*30 out of 67 drugs tested are counterfeit medicines
** computed at 10% reduction annually

STRATEGIES FOR 2011-2016

Strengthen education and advocacy campaigns to increase local acceptability of generic medicines.
Enhance the monitoring and regulatory functions of the NCPAM.
Improve the efficiency of existing institutions such as the FDA, the BNBs and BnBs and their
coordination with other stakeholders such as MeTA.
Gather relevant data for the formulation of evidence-based solutions in addressing the problem of
irrational drug use and other barrier to drug access
Sustain and manage the implementation of the law in the LGUs particularly the exercise of regulation
by FDA representatives in provinces and cities, as well as the investments for the management, drug
procurement, and construction of new BnBs.

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4.3. HEALTH HUMAN RESOURCES

Human resources for health (HRH) is defined as the group of individuals in the formal and informal health
sector that seek to protect, promote, and improve population health, equitable distribution and mobilization,
and strategic utilization in order to meet the health systems goals (World Health Organization, 2006).

The Philippines produces human resources for professional and non-professional fields, and is at the
forefront of global human resource exchange, especially in the health sector. The country is known as the
leading exporter of nurses and the second major exporter of physicians (WHO 2009).Human resources
include the following: doctors, nurses, midwives, nutritionist and other health professionals. Table 15 shows
the type of health human resources available and their corresponding employment category. For most part of
the decade, the country experienced increasing migration of its health professionals, with a consequent
shortage of HRH in the country.

TABLE 15. DISTRIBUTION OF SELECTED HEALTH PROVIDERS ACCORDING TO EMPLOYMENT


CATEGORY OF AFFILIATION

Nutritionist Occupational Med Physical


Category Doctor Nurse Midwife Dentist Pharmacist Total
/ Dietitian Therapist Tech Therapist
No
5,953 9,936 7,953 902 403 1,931 67 2,438 181 29,764
Information
Permanent
2,963 13,114 4,881 580 428 812 22 1,813 196 24,809
Full-Time
Permanent
861 188 20 20 14 15 1 29 10 1,158
Part-Time
Contractual 1,305 1,965 535 31 20 53 1 144 27 4,081
Visiting
2,041 4 4 25 0 0 0 0 2 2,076
Consultant
Casual 24 646 363 11 5 29 4 46 18 1,146
Volunteer 10 998 57 0 0 1 0 5 2 1,073
Multiple
3,622 498 272 96 37 107 1 215 12 4,860
Affiliations
TOTAL 16,779 27,349 14,085 1,665 907 2,948 96 4,690 448 68,967

However, even with the increasing migration of health professionals, the most recent WHO report on the
country concludes that there is still a high unemployment rate for health professionals despite the large
number of vacancies in rural areas. Factors suspected in this deficiency include emigration of Filipino health
workers, a weak HRH information system, and the existing condition wherein health workers flock to already
crowded urban areas, leaving rural areas unmanaged by physicians (Lorenzo, 2007).
Data on health workers in the public sector show that the concentration of health workers is highly variable
across regions (Table 16). The number of health professionals in the public sector per 100,000 population is
high in regions like NCR and CAR, while there is a noticeable scarcity of health professionals relative to the
population size in regions like ARMM.

Page | 32
TABLE 16. NUMBER OF HEALTH PROFESSIONALS IN THE PUBLIC SECTOR,
BY REGION, PHILIPPINES, 2008

Frequency Per 100,000


Area
Doctors Nurses Midwives Doctors Nurses Midwives
Philippines 2,838 4,576 17,473 3.2 5.2 19.7
NCR 590 723 1,135 5.1 6.3 9.8
CAR 89 131 637 5.9 8.6 41.9
Region 1 159 259 1,014 3.5 5.7 22.3
Region II 97 196 839 3.2 6.4 27.5
Region III 278 441 1,662 3.1 4.9 18.3
Region IV-A 238 472 1,818 2.0 4.0 15.5
Region IV-B 83 142 555 3.2 5.5 21.7
Region V 157 273 1,072 3.0 5.3 20.6
Region VI 234 401 1,775 3.4 5.9 26.0
Region VII 177 328 1,534 2.8 5.1 24.0
Region VIII 155 201 904 4.0 5.1 23.1
Region IX 100 203 697 3.1 6.3 21.6
Region X 138 241 3.5 6.1
Region XI 75 127 743 1.8 3.1 17.9
Region XII 113 114 615 3.0 3.0 16.1
Region XIII 79 114 615 3.4 5.0 26.8
ARMM 76 130 507 1.8 3.2 12.3
*Calculated using Philippines Statistical Yearbook 2010

To address the inadequate distribution of HRH in the country, the CHTs together with the registered nurses,
through the RNheals program, will be deployed to provide families with health information and guide them
to the assigned health facilities and preferred referral facility. The range of information can include health
risks, the needed services to address the risks, the available providers (including their location, services, costs,
operating hours and level of quality) and their benefits or entitlements. Furthermore, families will also be
guided on how to access services and how to finance the cost of care, particularly in terms of availing of
NHIP benefits. The CHTs will be recruited from among community health volunteers such as barangay health
workers, barangay nutrition scholars and barangay officials.

In addition, deployment programs such as Doctors to the Barrios (DTTB), DTTB-Leaders for Health
(DTTB-LHP), Rural Health Team Placement Programs (RHTPP), and Specialist to the Provinces (STTP) will
be enhanced.

Page | 33
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Guarantee adequate supply and equitable distribution of human
resources for health in the country.

Strategic Objectives Indicator Data Source Latest Baseline 2016 Targets


Number of CHTs and
DOH Program 0 CHTs 100,000 CHTs
RNheals deployed to
Report 0 RNheals (2010) 22,500 RNheals
achieve the MDGs
80 DTTBs
50 each (Dentists,
Med Techs and 300 DTTBs
HRH supply is Number of doctors, other
Nutritionist- 1,000 other allied HRH
adequate and allied health professionals DOH Program
dietitian)
distribution of and midwives deployed in Report
175 Rural Health
HRH is equitable the areas of need
Midwives 3,000 RHMs
(RHMs)
(2010)
% Filled-up positions
DOH Program 80% authorized
based on approved staffing 100%
Report (2010)
Capacity of health Number of certificate
DOH Program
work force to courses leading to post- 1 (2010) 2
Report
support national graduate program
and local health Number of HRH systems
systems is DOH Program
and programs 4 (2010) 6
Report
enhanced institutionalized

STRATEGIES FOR 2011-2016

Deploy CHTs and RNheals to the communities and enhance existing deployment programs such as
the Doctors to the Barrios (DTTB), DTTB-Leaders for Health (DTTB-LHP), Rural Health Team
Placement Programs (RHTPP), and Specialist to the Provinces (STTP) aligning them to KP
objectives
Through the HRH network, make health science education more community-oriented through a
unified community-based curriculum that produces a broad range of health workers with
competencies that are relevant to the countrys needs
Prioritize the reduction of the percentage of vacancies of HRH in rural health facilities and other
areas and also strengthen the capability of human resources to support national and local health
systems
Constantly update and utilize the National Database on Selected Human Resources for Health
Information System (NDHRHIS) as a tool to address the inequitable HRH distribution
Enhance personnel administration systems and processes to effect improvement of health workforce
outcomes through incentive mechanisms

Page | 34
ATTAINING BETTER HEALTH OUTCOMES
5.1. HEALTH-RELATED MDGs

The attainment of the health-related Millennium Development Goals (MDGs) is one of the strategic thrusts
of the Kalusugan Pangkalatan. MDGs are a set of social objectives that need to be accomplished by 2015 as
part of the countrys global commitment. Based on the National Statistical Coordination Board MDG watch,
some indicators seem to be on the right track while others show limited progress. This section describes the
countrys objectives that are contributory to reaching health-related MDGs by 2015.

5.1.1. MDG 1: ERADICATE EXTREME POVERTY AND HUNGER

Halve, between 1990 and 2015, the proportion of people who suffer from hunger (Target 1.C)

Many are still suffering from extreme hunger especially in regions with high poverty incidence despite
programmatic and policy efforts to contain the gaps in food security. Consequently, a significant proportion
of the countrys population especially children are malnourished and underweight.

In different rounds of National Nutrition Survey of FNRI, there is a noticeable improvement in the
nutritional status of children aged 0-10 years old from 2001 to 2005. However, there was a noted increase in
the prevalence of underweight and stunting in 2008 (see Figure 11). This may be due to the lack of
interventions among under-five children after 6 months of age.

FIGURE 11.TRENDS IN MALNUTRITION AMONG CHILDREN, PHILIPPINES, 2001, 2003 AND 2008.

50 34
45 32
Prevalence

_Prevalence

40 30
35 28
30 26
25 24
20 22
20
1990
1992
1993
1996
1998
2001
2003
2005
2008

2001 2003 2005 2008

Stunting among 0-5 years old Underweight among 0-5 years old
Stunting among 6-10 years old Underweight among 6-10 years old
Source: National Nutrition Surveys
Page | 35
Iron Deficiency Anemia (IDA) is the most common form of anemia. In the Philippines, half of infants aged 6
months-12 months have IDA (see Table 17). The prevalence significantly declined from 66 percent in 2003
to 58 percent in 2008(Food and Nutrition Research Institute, 2008). Like infants, pregnant mothers are also
at risk for IDA. In 2008, 43 percent of pregnant mothers were diagnosed with IDA, which is a decrease from
44 percent in 2003(Food and Nutrition Research Institute, 2008). For lactating mothers, the prevalence also
decreased from 42 percent in 2003 to 31 percent in 2008(Food and Nutrition Research Institute, 2008). With
regard to Vitamin A Deficiency (VAD), the prevalence of VAD among under-5 children increased from 35
percent to 40 percent in 2003(Food and Nutrition Research Institute, 2008). However, a significant
improvement was observed in the year 2008 (see Table 18).

TABLE 17. PREVALENCE OF IRON DEFICIENCY ANEMIA AMONG DIFFERENT DEMOGRAPHIC GROUPS,
PHILIPPINES, 1993-2008

Age Group 1993 1998 2003 2008


6- 1year 49.2 56.6 66.2 55.7
1-5 years old 25.1 29.6 29.6 20.8
6-12 years 42 35.6 37.4 19.8
Pregnant women 43.6 50.7 43.9 42.5
Lactating women 43.0 45.7 42.2 31.4
Source: National Nutrition Surveys

TABLE 18. PREVALENCE OF VITAMIN A DEFICIENCY AMONG DIFFERENT DEMOGRAPHIC GROUPS,


PHILIPPINES, 1993-2008

Age Group 1993 1998 2003 2008


6 months-5 years 35.3 38.0 40.1 15.2
Pregnant women 16.4 22.2 17.5 9.5
Lactating women 16.4 16.5 20.1 6.4
Source: National Nutrition Surveys

There are recommended public health practices that would ensure infant and child nutrition. Exclusive
breastfeeding is the most effective and economic way of nourishing infants. Many studies have shown the
positive health outcomes of optimal breastfeeding on infant nutrition and survival. In the Philippines, the
prevalence of exclusive breastfeeding in 2008 is as it was similar to the prevalence in 2003 (33.5 percent and
34 percent, respectively) (National Statistics Office, 2008). No significant improvement was observed.

The country has made significant improvements in reducing the prevalence of micro-nutrient deficiencies.
However, other nutrition indicators like stunting and underweight have worsened. The following table
summarizes the countrys objective in reducing hunger and malnutrition.

Page | 36
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOALS:
Protein energy malnutrition and iron deficiency anemia are reduced.
Vitamin A and iodine deficiencies are eliminated as public health problems.
Nutritional risk factors and their health-related effects are managed.

Strategic 2016
Indicator Data Source Baseline
Objective Targets
% Households with per
66.9
capita intake below 100% FNRI-NNS 32.8
(2008)
dietary energy requirement
19.6
% Low birth weight infants NSO-NDHS <19.6
(2008)
The proportion of % Underweight children 20.6 12.7
FNRI-NNS
people who suffer under five years old (2008)
from hunger and Infants: 55.7 (2008) <40
malnutrition are % of Iron Deficiency
FNRI-NNS Pregnant: 42.5
reduced Anemia (IDA)
(2008) <40

% Under-five children with 15.2


<15
Vitamin A Deficiency FNRI-NNS (2008)
(VAD)
% Children exclusively 34
NSO-NDHS 54.75*
breastfed until 6 months (2008)
* Computed at a rate of 10 percent increase per year

STRATEGIES FOR 2011-2016

Target the nutritionally at-risk and vulnerable. Priority will be given to areas with high prevalence of
under-nutrition and micronutrient deficiencies and to children 0-5 years old, pregnant, and lactating
mothers using the CHTs.
Promote optimum infant and young child feeding practices in various settings to reduce the
prevalence of underweight and stunted under-five children
Adopt and implement appropriate guidelines for the community-based management of acute
malnutrition
Integrate and strengthen nutrition services in the maternal continuum of care (ante-natal, delivery,
post-partum care)
Deliver an integrated package of nutrition services in the school and alternative school system
Increasing the supply and consumption of micronutrients to reduce or maintain the prevalence of
vitamin A deficiency and iodine deficiency disorders to levels below public health significance

Page | 37
5.1.2. MDG 4: REDUCE CHILD MORTALITY

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate (Target 4.A)

Many studies suggest that child mortality indicators are the most sensitive markers of the general health care
status of a country. According to NSCB, the countrys progress in reducing the infant mortality rate is on
track, and there is a high chance of meeting the target by 2015.The infant mortality rate decreased from 57
per 1000 livebirths in 1990 to 25 livebirths in 2008 (see table in chapter 1 on child mortality data). However,
other components of child mortality like perinatal and neonatal mortality should also be highlighted as they
are reflective of the other specific gaps in public health interventions during prenatal care and maternal
delivery.

Optimal health practices like breastfeeding, Vitamin A administration, and newborn screening can
dramatically decrease infant mortality. In the Philippines, only half of infants are breastfed within the first
hour of life despite the promotion of optimal breastfeeding practices in health facilities. The prevalence of
early breastfeeding in the years 2003 and 2008 were relatively the same, suggesting no improvement (54
percent vs. 53.5 percent).

FIGURE 12. TREND OF FULLY-IMMUNIZED CHILDREN AND


CHILDREN WITH NO VACCINATION, 1998, 2003 and 2008
Vaccination is one of the essential
public health interventions. Figure 12
79.5
72.8 69.8 shows that in the Philippines, 79
80
percent of children are fully
60 immunized (National Statistics Office,
Percent

1998
40 2008). However, there are 5.6 percent
2003
children not administered with any
20 7.7 7.3 5.6 2008
form of vaccination in 2008(National
0
Statistics Office, 2008). The rate of
FIC Coverage Children with no
vaccination fully immunized children is low in
ARMM, MIMAROPA and Bicol
(National Statistics Office, 2008).
Source: National Demographic and Health Survey, 1998, 2003 and 2008

Tuberculosis, caused by Mycobacterium tuberculosis, is one of the top causes of morbidity and mortality in the
country. The risk of developing the disease is highest in children under three years old, but the true scope of
the disease among children is unknown. BCG vaccine, given immediately upon birth, provides the greatest
possible protection from tuberculosis. BCG coverage among infants is 90.3 percent as reported in the NDHS
2008.

Page | 38
DPT is one of the vaccines that prevent three important diseases: Diphtheria (caused by C. diphtheria),
Pertussis (caused by B. pertussis) and tetanus infection (caused C. tetani). The morbidity and mortality rates of
these diseases are declining (see Figures 13-15). The coverage for the three doses as reported in the NDHS
2008 is 92.5 percent for DPT 1, 89.6 percent for DPT 2 and 85.6 percent for DPT 3 (National Statistics
Office, 2008).

FIGURE 13. TRENDS IN DIPTHERIA MORBIDITY AND MORTALITY, PHILIPPINES, 1980-2005

5 1.2
Morbidity rate per 100,000 population

Mortality rate per 100,000 population


4 1
0.8
3
0.6
2
0.4
1 0.2
0 0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
MORBIDITY MORTALITY

Source: Philippine Health Statistics, 2005

FIGURE 14. TRENDS IN PERTUSSIS MORBIDITY AND MORTALITY, PHILIPPINES, 1980-2005

45 1

Mortality Rate per 100,000 population


Morbidity Rate per 100,000 population

40 0.9
35 0.8
30 0.7
0.6
25
0.5
20 0.4
15 0.3
10 0.2
5 0.1
0 0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

MORBIDITY MORTALITY

Source: Philippine Health Statistics, 2005

Page | 39
FIGURE 15. TRENDS IN TETANUS NEONATORUM, PHILIPPINES, 1995-2010

0.14

Rate per 1,000 livebirths


0.12
0.1
0.08
0.06
0.04
0.02
0

Source: Field Health Service Information System, 1995-2010


OPV vaccination coverage has improved slightly over the three censal periods. However, coverage decreases
across the immunization schedule. Given the high coverage rate for polio vaccine, reported cases of acute
flaccid paralysis has been limited to the Bicol region with 48 cases reported in 2009. The coverage rates of the
three dose periods of OPV vaccine are 92.6 percent, 90 percent and 85 percent, respectively (National
Statistics Office, 2008).

Measles or rubeola is caused by the measles virus; a single stranded RNA virus of the genus Morbillivirus. A
decreasing trend for morbidity and mortality rates were also noted but there are periods of resurgence of
cases every two to three years due to the build-up of un-immunized children (see Figure 16).

FIGURE 16. TRENDS IN MEASLES MORBIDITY AND MORTALITY, PHILIPPINES, 1980-2005

160 25
Mortality rate per 100,000 population

Mortality rate per 100,000 population

140
20
120
100 15
80
60 10
40
5
20
0 0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
MORBIDITY MORTALITY

Source: Philippine Health Statistics, 2005

Page | 40
Though the country made significant strides in reducing infant mortality, other child indicators signal policy
makers to push for more program and targeted policy efforts to facilitate the decline of child mortality in the
country. The table below summarizes the countrys objectives in decreasing infant and child mortality.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Reduction of under-five mortality rate by two-thirds.

Strategic Latest
Indicator Data Source 2016 Targets
Objective Baseline
Perinatal mortality rate per 28
NSO-NDHS 18.7*
1,000 live births (2008)
Neonatal mortality rate per 16
Child mortality NSO-NDHS 10
1,000 live births (2008)
is reduced
Infant Mortality Rate per 25
NSO-NDHS 17
1,000 live births (2008)
Under-five mortality rate 34
NSO-NDHS 25.5
per 1,000 live births (2008)
% Newborn initiated
breastfeeding immediately NSO-NDHS 53.5 (2008) 86**
after birth
Provision of % Infants initiated
quality services complementary feeding at 6 NSO-NDHS 36.54 (2008) 58**
for children is months of age
increased % Under 6 years old given
NSO-NDHS 74.8 (2008) 90
Vitamin A
% Newborns screened for 30
NIH-NSRC 100***
metabolic disorders (2010)
Routine % FIC NSO-NDHS 81 (2008) 95
immunization % Measles coverage NSO-NDHS 79 (2008) 95
coverage is
% TT2+ NSO-NDHS 47.7 (2008) 80
increased
*computed based on 2/3 reduction from the baseline
** computed at a rate of 10 percent increase per year
*** computed at a rate of 30percent increase per year

STRATEGIES FOR 2011-2016


Promote universal access to the standard child survival package of interventions. Priority will be
given to areas with high prevalence of under-five mortality rate using the CHTs.
Routine vaccination of all infants ages 0-11 months adopting the Reaching Every Barangay strategy
Supplemental immunization activity either as small scale or large scale immunization
Enhance the capacity and coordination of the service delivery networks as channels of child survival
interventions.
Create opportunities for communities to overcome barriers to utilization of child survival (CS)
services.
Build the LGUs resolve to adopt and implement the CS Strategy.
Harmonize efforts of DOH, allied agencies and partners in supporting local delivery of CS services.

Page | 41
5.1.3. MDG 5: IMPROVE MATERNAL HEALTH

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio (Target 5.A)

Maternal mortality is defined as the death of a woman while pregnant or within 42 days after pregnancy
termination. Since this arises from the risks attributable to pregnancy and childbirth as well as from poor
quality health care services, this is a strong indicator for health care status. By cautiously examining the trend
as shown in Figure 17, there was a noticeable decline in maternal mortality ratio from 209 maternal deaths
per 100,000 livebirths to 162 maternal deaths per 100,000 livebirths (National Statistics Office, 2007). The
MMR is estimated to be at 163 per 100,000 live births as of 2010 (NSCB, 2010).

FIGURE 17: TRENDS IN MATERNAL MORTALITY RATIO, PHILIPPINES, 1990-2006


AND 2015 MDG TARGET

250

200

150

100

50

0
1990 1991 1992 1993 1994 1995 1998 2006 2015
(target)

Source: NSO 1993 and 2008; National Demographic and Health Survey 1993 and 2003 and Family planning
Survey 2007

The underlying causes of maternal deaths are: delay in taking critical actions, delay in seeking care, delay in
making referral and delay in providing appropriate medical management. Other factors that contribute to
maternal deaths are: unplanned, mistimed and unwanted pregnancies, poor detection and management of
high-risk pregnancies, poor access to health facilities brought about by geographic distance and cost of
transportation, and lack of staff competent in handling obstetrical emergencies. Analysis of the causes of
maternal deaths shows hypertension and postpartum hemorrhage as the leading causes (Table 19).

Page | 42
TABLE 19: PERCENT DISTRIBUTION OF THE MAIN CAUSES OF MATERNAL MORTALITY, PHILIPPINES,
2000 AND 2005

Causes of Maternal Mortality 2000 2005


Hypertension complicating pregnancy, childbirth and
25.4 29.4
puerperium
Postpartum hemorrhage 20.3 15.2
Pregnancy with abortive outcome 9.0 8.0
Hemorrhages related to pregnancy 0.1 0.1
Other complications related to pregnancy occurring in the
45.3 47.3
course of labor, delivery and puerperium
Total 100.0 100.0
Source: Philippine Health Statistics 2005

In the Philippines, 73 percent of mothers do not want additional children or want to delay pregnancy.
However, the mean number of children ever born to a Filipino woman upon reaching the age of 40-49 is four
with an average fertility rate of 3.3 in the year 2008 (National Statistics Office, 2008).

The high fertility rate coincides with the low contraceptive prevalence rate of 51 percent among all Filipino
women of reproductive age and 70.6 percent among married women. Figure 18 shows that the highest
percentage of contraceptive use belongs to the 35-39 age group while the 15-19 years old group have the
lowest percentage of ever using any contraceptive method (National Statistics Office, 2008). Figure 19 shows
the distribution by age according to the type of contraceptive method used.

FIGURE 18: PERCENTAGE OF WOMEN AGE 15-49 WHO HAVE EVER USED ANY
CONTRACEPTIVE METHOD, PHILIPPINES, 2008

80
70
60
Percentage

50
40
30
20
10
0
15-19 20-24 25-29 30-34 35-39 40-44 45-49

2003 2008

Page | 43
FIGURE 19: PERCENTAGE OF WOMEN AGE 15-49 WHO HAVE EVER USED MODERN
AND TRADITIONAL METHOD, PHILIPPINES, 2008

80
70
60
Percentage

50
40
30
20
10
0
15-19 20-24 25-29 30-34 35-39 40-44 45-49

Any Method Modern Traditional

Pregnancy is a physiologic process that has risks to both the mother and the unborn. At greater risk are
women below 18 years old and those who are more than 35 years old. Chronic illnesses such as iron
deficiency anemia, tuberculosis, hypertension, cardiovascular disorders, and diabetes in pregnancy are risks
that could harm both the mother and the unborn.

Table 20 shows that the percentage of pregnant women with at least four prenatal visits increased from 70.4
percent in 2003 to 78 percent in 2008 (National Statistics Office, 2008). In addition, pregnant women who
received at least two doses of tetanus toxoid also increased from 37 percent in 2003 to 48 percent in 2008
(National Statistics Office, 2008). The proportion of births attended by health professionals increased from
60 percent in 2003 to 62 percent in 2008 (National Statistics Office, 2008). Still, a significant portion of
pregnant women do not have access to prenatal care and professional births attendants, which increase the
occurrence of pregnancy-related complications.

TABLE 20. HEALTH-RELATED PRACTICES AFFECTING MATERNAL HEALTH, PHILIPPINES,


1998, 2003 AND 2008

Indicators 1998 2003 2008

% of pregnant women with at least 4 prenatal


77 70.4 77.8
visits
% of pregnant women with at least 2 doses of
tetanus toxoid 38 37.3 47.7
% of births attended by professional, health
56 59.8 62.2
providers
% of women with at least 1 postnatal visit
within one week of delivery up to 41 days 43 51.1 90.4*
Source: National Demographic and Health Surveys, NSO
*Postnatal visit in 2008 includes visit up to 41 days
Page | 44
The Philippines needs to fast-track efforts in reducing the maternal mortality (National Economic and
Development Authority, 2011). For the country to reduce the MMR from 163 to 52 by 2015 and achieve the
MDG 5, wider and more concerted efforts of the government and different stakeholders to implement MCH
programs is needed. The following table summarizes the countrys objectives in reducing maternal deaths,
and improving the well-being of the unborn.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Improve maternal health and ensure the survival, health and well-being
of mothers and their unborn.

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets


Maternal Mortality
Maternal Mortality is 163
Ratio (MMR) per NSCB 50
reduced (2010)
100,000 live births
% Pregnant women
52
with 4 or more prenatal DOH-FHSIS 90
(2010)
visits
% Pregnant women
26.3
who are nutritionally- FNRI-NNS 22.4
Provision of quality (2008)
at-risk
services for mothers is
% Deliveries assisted by 62
increased NSO-NDHS 90
skilled birth attendants (2008)
% Deliveries in a health 44
NSO-NDHS 90
facility (2008)
% Contraceptive 51
NSO-NDHS 65
prevalence rate (2008)

STRATEGIES FOR 2011-2016


Provide information on FP-MCH through the CHTs and other organized local efforts
Ensure availability of reproductive health and other pre-pregnancy services including adolescent
health and control of sexually-transmitted infections and HIV prevention services through local
public health authorities.
Increase competencies of health providers in providing comprehensive reproductive health and
maternal and child health services.
Promote facility-based births attended by skilled health professionals catering to the specific needs of
the mother and the newborn (Essential Newborn Care).
Immediate postpartum and postnatal care by skilled health professionals to include immediate and
thorough drying, skin-to-skin contact, properly-timed cord clamping, sustained contact for initiation
of breastfeeding within the first hour.
Presence of local capacities for securing reliable, updated and complete information about the use of
health services on maternal and child health.

Page | 45
5.1.4. MDG 6: REVERSE THE SPREAD OF HIV/AIDS, MALARIA AND OTHER INFECTIOUS
DISEASES

The Millennium Development Goal (MDG) 6 aims to control the most common infectious diseases
particularly, tuberculosis, malaria and HIV. These diseases have been hampering social progress in many parts
of the world especially in Africa and Asia. In the Philippines, tuberculosis and malaria are still major public
health problems especially in certain segments or areas in the country.

5.1.4.1. Have halted by 2015 and reversed the spread of HIV/AIDS (Target 6.A)
FIGURE 20. NUMBER OF HIV AND AIDS CASES,
PHILIPPINES, 1984-2010
The prevalence of HIV in the
900
800 Philippines is less than 1 percent
700 (Department of Health, 2010).
600 However, noticeable and
500
AIDS exponential rise of HIV and AIDS
400
300 HIV cases in the country for the past
200 years have raised alarming concerns
100
(see Figure 20). Over the last two
0
decades, there has been a constant
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010

increase of patients diagnosed with


Source: STI/HIV/AIDS Surveillance Technical Report, PNAC HIV and AIDS. In 2010, 539
patients were diagnosed with HIV
FIGURE 21. TRENDS IN GONORRHEA AND SYPHILIS (Department of Health, 2010).
MORBIDITY, PHILIPPINES, 1980-2005
However, given the limitations of
30 the AIDS surveillance and reporting
25 system which upholds voluntary
20 testing and confidentiality, this
15
number may underestimate the real
10
number of HIV and AIDS cases.
5
0
The growing cases of HIV can be
attributed to risky behaviors which
include unprotected sex, switching
Gonorrhea Cases (per 100,000 population) from one partner to another and
Syphilis Cases (per 100,000 population) needle sharing among drug users
(Farr & Wilson, 2010).

Page | 46
HIV/AIDS is known to have co-morbidity with other STIs such as gonorrhea, syphilis and herpes. Based on
the Philippine Health Statistics 2005, the reported cases of gonoccoccal infection caused by Neisseria Gonorrhea
has significantly decreased from 27.4 cases per 100,000 population in 1985 to 0.0 cases per 100,000
population in 2005 (see Figure 21). In the case of syphilis, which is caused by T. pallidum, the reported cases
have constantly remained low (Department of Health, Various years).

The prevalence of HIV is low at the present. Given the continuous trend of increase in the number of HIV
cases, it is likely that the HIV prevalence will increase. The countrys objective is to maintain the level of cases
to less than 1 percent HIV prevalence rate, and to reduce the transmission of HIV virus. The next table
summarizes the countrys objective in the next 5 years with regard to HIV/AIDS prevention and control.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Reduce new STI and HIV infections by 50 percent among the most-at-
risk and vulnerable population by 2016

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
HIV prevalence of
less than 1% is % Prevalence of HIV DOH-IHBSS 0.57 (2009) <1.0
maintained
% Incidence of
gonococcal infection DOH-SSESS 11.3 (2009) 5.65*
STI among MARP
among at risk males
is reduced
% Incidence of NGI
DOH-SSESS 12.6 (2009) 6.3*
among at risk females
The transmission of
RTIs in the general
population and
Condom use rate NSO-NDHS 2.3 (2008) 5
among the
vulnerable groups is
reduced
* Computed based on 50 percent reduction from the baseline

STRATEGIES FOR 2011-2016

Expand HIV counseling and testing and enabling people at risk to know their HIV status.
Maximize prevention in a wide range of activities involving health and other sectors, complemented
with the availability and access to essential prophylactic commodities like condoms and ART to
prevent mother to child transmission of HIV.
Scale-up treatment, care and support. For infants, children or adults living with HIV, a
comprehensive package of prevention, treatment and care interventions should be made available.
Early referral after HIV diagnosis is essential especially pregnant women to prevent MTCT.
Invest in strategic information. This includes surveillance of HIV and sexually transmitted infections,
monitoring and evaluation and continuing research for vulnerabilities and operations researches.

Page | 47
Strengthen health systems.HIV and AIDS shall be integrated at all possible entry points in the health
system. Other activities include the advocacy for the institutionalization of local AIDS councils and
training of regional assistance team to provide assistance to LGUs in setting-up/ sustaining local
AIDS councils.

5.1.4.2. Have halted by 2015 and reversed the spread of Tuberculosis (Target 6B)

Tuberculosis is one of the leading causes of mortality and morbidity in the country. In the Philippines,
majority of the indicators for TB has decreased through the years with smear positive and culture positive
registering the most marked decrease in prevalence as shown in Table 21.

TABLE 21. PREVALENCE OF TUBERCULOSIS, PHILIPPINES, 1982, 1997 AND 2007

Indicator 1981-1982 1997 2007


Smear positive TB cases/1,000 6.6 3.1 2.0
Culture positive TB cases/1,000 8.6 8.1 4.7
Radiographic findings suggestive of TB (%) 4.2 4.2 6.3
Multi-drug resistant TB among new case (%) 1.5 2.1
TB symptomatic (%) 17 18.4 13.5
Annual risk of infection (%) 2.5 2.4 2.1

FIGURE 22. TRENDS IN TB CASE DETECTION RATE (CDR) AND CURE


RATE (CR), PHILIPPINES, 2000-2008

100 .MDR TB among new cases has


increased slightly after a decade.
90
The noticeable improvement of
80
TB prevalence over the last
70
decade can be attributed to
60
program efforts, particularly the
50
TB DOTS Program. From 2000
40 to 2008, the case detection rate
2000 2001 2002 2003 2004 2005 2006 2007 2008
and treatment success rate
Case Detection Rate Cure Rate Treatment Success Rate increased (see Figure 22).

Despite the decline in TB prevalence, this curable and preventable disease is still one of the top causes of
morbidity and mortality. The next table summarizes the countrys objective in reducing TB morbidity and
mortality in the next five years.

Page | 48
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Morbidity and mortality from tuberculosis are reduced.

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets


Mortality rate from
Mortality rate from TB
TB per 100,000 DOH-PHS 41 (2007) 33
is reduced
population
TB Prevalence rate is TB Prevalence rate
DOH-NTPS 486 (2008) 387
reduced per 100,000
Case detection rate for % Case detection
DOH Program
all forms of TB is rate of sputum 73 (2008) 85
Report
increased positive cases
% Cure rate of
Cure rate of new smear DOH Program
sputum positive 79 (2008) 85
positive TB is increased Report
cases
TB treatment success % Treatment success DOH Program
89 (2010) 90
rate is improved rate Report

STRATEGIES FOR 2011-20161

Localize TB control program implementation. LGUs manage and implement the TB control
program within the decentralized health system in support of the health sector reform initiatives.
Monitor health system performance. Regularly determine the progress in TB control efforts as
influenced by the initiatives of public and private institutions and by actions in health system
strengthening.
Engage both public and private TB care providers to adopt DOTS. The development and
maintenance of competent workforce for TB control is a key activity of the national TB control
program.
Promote and strengthen positive behavior of communities. The utilization of DOTS services,
especially by the poor and marginalized, can still be improved through interventions that facilitate
care seeking at DOTS facilities, compliance with diagnostic procedures, and adherence to treatment.
Address MDR-TB co-infection and needs of vulnerable populations. There is a need to detect most
of the MDR-TB cases and ensure that they receive quality-assured second-line anti-TB drugs. It shall
target vulnerable populations such as the poor, children, elderly, refugees, inmates and those living in
geographically isolated and depressed areas.
Regulate and make available quality TB diagnostic tests and anti-TB drugs. Availability of quality-
assured diagnostic tests and standardized treatment are keys to prompt diagnosis and treatment of
TB cases.
Certify and accredit TB care providers. Seventy (70) percent of DOTS facilities must be
DOH/PhilCAT-certified and PhilHealth accredited.
Secure adequate funding and improve efficiency of fund utilization. Ensure adequate financing for
PhilPACT key strategies, particularly in strengthening local implementation of TB prevention and
control and efficiency in fund utilization by proper and timely disbursement of funds with tracking
mechanism.

1 Philippine Plan of Action to Control Tuberculosis 2010-2016


Page | 49
5.1.4.3. Have halted by 2015 and begun to reverse the incidence of malaria and other diseases (Target 6C)
Malaria is the most common and most persistent mosquito-borne infection in the Philippines although cases
and deaths have gone down. Endemic areas are usually rural, hilly or mountainous, and hard to reach. High-
risk groups consist of upland subsistence farmers, forest-related workers, indigenous people, settlers in
frontier areas, and migrant agricultural workers. Disease transmission is perennial and generally higher during
the rainy season.

FIGURE 23. MORBIDITY AND MORTALITY RATE OF MALARIA, PHILIPPINES, 1980-2005

250

200

150

100

50

0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
MorbidityRate per 100,000 population Mortality Rate per 100,000 population

Source: Philippine Health Statistics, 2005

Over the last decades, the morbidity and mortality rates of malaria have been declining as shown in Figure
23. The morbidity rate of 80 per 100,000 in 1980 dropped to 42 per 100,000 in 2005, while the mortality rate
declined from 2.2. per 100,000 in 1980 to 0.2 per 100, 000 in 2005 (Department of Health, 2005).
In 2010, the Malaria Control Program (MCP) introduced the micro-stratification in classifying malaria
endemic areas in the country according to the rate of malaria transmission for better tracking of malaria cases,
prioritization of endemic areas to be assisted and to ensure more focused interventions.

Page | 50
Definition of Strata
Stable Risk
With at least 1 barangay that has a continuous presence of at least one indigenous malaria case in a month for 6
months or more at any time during the past three years
a. high
With> 1000 average malaria cases from 2007-2009
b. moderate
With 100 to <1000 average malaria cases from 2007-2009
c. low
With <100 average malaria cases from 2007-2009

Unstable Risk
With at least 1 barangay that has a continuous presence of at least one indigenous
malaria case in a month for less than 6 months at any time during the past three years

Epidemic Risk or Sporadic Risk


With at least 1 barangay that has a presence of at least one indigenous
malaria case at any time in the past 5 years

Malaria Free
Absence of indigenous malaria case for 5 past years even in the presence of
malaria vector

FIGURE 24. MALARIA ENDEMIC PROVINCES PHILIPPINES, 2010


.

Micro-stratification is based on the rate or degree of


malaria transmission classified as: (i) stable risk, (ii)
unstable risk, (iii) sporadic/epidemic risk; and (iv) malaria-
free. Provinces with stable malaria transmission were
further sub-classified into high endemic, moderate
endemic and low endemic (Malaria Medium Term
Development Plan 2011-2016)

Page | 51
NATIONAL OBJECTIVES FOR 2011-2016

OVERALL GOAL: To accelerate the transition from control to sustained elimination of the
disease.

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
Malaria cases are Malaria morbidity rate per DOH Program
22 (2009) 6.6
reduced 100,000 population Report
Malaria deaths are Malaria mortality rate per DOH Program
0.03 (2009) <0.03
reduced 100,000 population Report
Annual parasite Annual parasite incidence
DOH Program
incidence is (API) per 1,000 endemic 1.7 (2010) 0.8
Report
reduced population
The number of
malaria-free
Number of malaria-free DOH Program
provinces is 23 (2009) 40
provinces Report
increased

STRATEGIES FOR 2011-20162

Ensure universal access to reliable diagnosis, highly effective and appropriate treatment and
preventive measures by levelling up focal anti-malaria interventions in stable and unstable risk areas
and sustaining provision of anti-malaria diagnostic, treatment and preventive measures in epidemic
risk and malaria-free areas, among others.
Capacitate LGUs to own, manage and sustain the Malaria Control Program in their respective
localities which include stratification, zoning and planning; malaria surveillance and response and
monitoring and evaluation
Sustain financing of anti-malaria efforts at all levels of operations by securing government and non-
government financial assistance in support to malaria elimination.
Ensure a functioning quality assurance system for malaria operations by strengthening Quality
Assurance System (QAS) for anti-malaria diagnostic and treatment facilities and improve quality of
vector control measures.

2
(Malaria Medium Term Development Plan 2011-2016)
Page | 52
5.1.5. MDG 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

All through time, water has been held as a life-sustaining element of the earth. Unfortunately, water has also
become the source of illness in our country. Recent reports indicate that only 14 million of over 17 million
households in the country (82.3 percent) have access to safe water supplies, and only about 13 million (76.8
percent) have sanitary toilets (Department of Health, 2008). However, the World Health Organization
(WHO) reports that most of these supplies consist of protected wells, tube wells, communal standpipes, and
rainwater harvesting. Only 45 percent of Filipino households (58 percent urban, 23 percent rural) are actually
connected to a piped-in distribution system. In an assessment done by the Department of Health (DOH),
water samples from improved wells were generally free of fecal contaminations at the source, but most were
contaminated at the point of consumption. In fact, 50 percent of them were heavily contaminated (Clasen,
2007).

Water and sanitation problems are major environmental health risks. They pose a threat to the entire
population causing diarrhea, cholera, typhoid fever, hepatitis A, skin diseases, and dengue fever, among
others (Department of Health, 2005)

Recent outbreaks of infectious diseases and disasters such as flooding and droughts impose a heavy burden
on the countrys health and health and economic resources (Clasen, 2007). Water and sanitation facilities that
were destroyed during the typhoons Ondoy and Pepeng now require rehabilitation.

The proportion of households within 30 minutes from water supply facilities is 95 percent in 2008 and the
proportion of households with water supply coming from improved sources is 69.8 percent in the same year
(National Statistics Office, 2008). In urban areas, piped water supply is at 38 percent in 2008 while it is just 22
percent in rural areas (National Statistics Office, 2008).

The rate of utilization of toilet facilities with septic tank is still the highest among types of toilet used in the
country. In 2008, the percent coverage of households with toilet facilities that flush into septic tanks in urban
areas is 66.9 percent, as compared to 40 percent in rural areas (National Statistics Office, 2008).

Page | 53
FIGURE 25. TREND IN THE PROPORTION OF THE POPULATION WITH ACCESS TO SAFE DRINKING
WATER AND SANITARY TOILET FACILITIES IN PERCENT, PHILIPPINES, 1991-2008

95
90
85
80
Prevalence

75
70
65
60
55
50
1991 1994 1997 1998 1999 2000 2002 2003 2004 2006 2007 2008 2015
MDG
target
Access to safe water Access to sanitary toilet facilities

Sources: FIES NSO and APIS, NSO

The trend in the proportion of the population with access to safe drinking water in the country has been
improving through the years as shown in Figure 25, reaching the levels of 81.4 percent in 2008 which is close
to the MDG target of 86.9 percent by 2015. The level of access to sanitary toilet facilities in 2008 of 88.6
percent has already exceeded the MDG target of 85.9 percent by 2015.

FIGURE 26. ACCESS TO SAFE DRINKING WATER AMONG THE LOWEST 30 PERCENT AND HIGHEST 70
PERCENT INCOME CLASS OF THE POPULATION, PHILIPPINES, 2008

100
86.9
90 81.4
80 71.8
70
60
Percent

50
40
30
20
10
0
Lowest 30% Highest 70% National

With access to safe water %

Source: APIS, NSO, 2008

Page | 54
The access to safe drinking water among the 70 percent highest income class (86.9 percent) is notably higher
by 15.1 percentage as compared to the lowest 30 percent income class of the population (71.8 percent) (see
Figure 26). This is also true with access to sanitary toilet facilities which is 95.5 percent among the 70
percent highest income class as compared to 76.5 percent among the lowest 30 percent income class of the
population (see Figure 27).

FIGURE 27. ACCESS TO SANITARY TOILET FACILITIES AMONG THE LOWEST 30 PERCENT AND
HIGHEST 70 PERCENT INCOME CLASS OF THE POPULATION, PHILIPPINES, 2008

100 95.5
88.6
76.5
80

60
Percent

40

20

0
Lowest 30% Highest 70% National

With access to sanitary toilet facilities %

Source: APIS, NSO, 2008

The population with the highest access to safe drinking water is found in Cagayan Valley (92.9 percent)
followed by Central Luzon (91.9 percent) and CALABARZON (87.7 percent). In terms of access to sanitary
toilet facilities, the population with the highest access is in NCR at 98.7 percent followed by Ilocos Region at
98.4 percent and CALABARZON at 98.2 percent (National Statistics Office, 2008). The ARMM lags behind
all regions in access to safe water and sanitary toilet facilities (Figure 28).

Page | 55
FIGURE 28. PROPORTION OF POPULATION WITH ACCESS TO SAFE WATER AND
SANITARY TOILET BY REGION, PHILIPPINES, 2008

Proportion of population with access to safe water in Proportion of population with access to sanitary toilet
percent by region, Philippines, 2008 facilities in percent by region, Philippines, 2008

Over the years, around 80 percent of households have continued to have access to safe water and sanitary
toilet facilities. The countrys objective is to further increase this proportion to 90 percent of households. The
following table summarizes the country objectives in increasing access to safe water and sanitary toilet
facilities.

Page | 56
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOALS:
Environmental health conditions in the country are improved.
Morbidity and mortality from environmental health hazards are reduced.

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets


Households with
% Householdswith
access to safe water is NSO-APIS 81.4 (2008) 88
access to safe water
increased
% Households
with sanitary toilet NSO-APIS 88.6 (2008) 90
facility
% Households
Households with NOH Midline
connected to sewer 34(2010) 40
sanitary toilet is Survey
system
increased
% Households
with septic tank NOH Midline
23.4(2010) 30
desludged for the Survey
last 5 years

STRATEGIES FOR 2011-2016

Increase investment in environmental health programs to target the whole population.


Develop technical assistance packages for stakeholders especially for the LGUs.
Develop a comprehensive communication package for environmental health concerns. This will
support stronger advocacy campaigns that will push for the local and nationwide implementation of
environmental laws through sustainable measures like low-cost waste treatment technologies
available in the market.
Strengthen capacity building and collaboration among partners.
Support environmental infrastructure development projects. This includes construction and
upgrading of regional and provincial laboratories for the use of environmental and occupational
health programs.

Page | 57
5.2. GOALS FOR OTHER DISEASES
5.2.1. COMMUNICABLE DISEASES
5.2.1.1. Diseases for Prevention and Control
5.2.1.1.1. Soil-Transmitted Helminthiasis and other Parasitoses

Soil-transmitted helminthiasis (STH) and other parasitoses are a group of parasitic infections that
commonly occur in areas where sanitation practices are poor. The three major causes of intestinal
parasitism in the Philippines are ascariasis or roundworm infection, trichuriasis or whipworm infection,
and hookworm infection. In 2009, STH prevalence is 43.7 percent among children aged one to five years
old and 44.7 percent among children aged six to twelve years old (Department of Health, 2009).

STH is high in poverty-stricken areas, where there are inadequate sanitary facilities and water supply and
poor personal hygiene. Children from ages one to twelve years old are one of the most important
population groups affected by these diseases. This age group has the highest prevalence rate and is the
greatest source of transmission for the infection. Other population groups at risk are pregnant women,
farmers, and indigenous people.

In order to bring down the prevalence rates of STH, mass deworming of school children is being done
every January and July each year as part of the Garantisadong Pambata Campaign. Furthermore, STH
control strategies have been integrated into the mass treatment programs for filariasis and schistosomiasis
endemic areas. However, only 67 percent of children aged 1-12 years old and only 38.6 percent of IP
schoolchildren were dewormed as of 2009 (DOH-DepED and WHO , 2009).

Soil-transmitted helminthes produce varied symptoms including intestinal manifestations (such as


diarrhea and abdominal pain) and general malaise and weakness. Hookworms, in particular, can even
cause anemia. The effects of these symptoms are detrimental to the childs school performance and to
the adults productivity.

The goal of the STH and Other Parasitoses Control Program is to reduce the STH prevalence among
children aged one to twelve years old and reduce the risk of pregnant women, adolescent females and
special groups for STH infection.

Page | 58
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Morbidity and other health effects of soil transmitted helminthiasis and
other parasitoses are reduced

Data
Strategic Objective Indicator Latest Baseline 2016 Targets
Source

Prevalence of STH Sentinel


% STH cases among 1- 5
and other parasitoses Surveillance 43.7 (2009) 34.96*
years old
among children is of STH
reduced
Sentinel
% STH cases among 6- 12
Surveillance 44.7 (2009) 35.76*
years old
of STH
% IP schoolchildren
Special Study 38.6 (2009) 30.88*
Coverage of dewormed
deworming services % Deworming coverage DOH-
67 (January 2009)
is increased among 1-12 year-old DepED 95
children Report

Proportion of
% Mothers/ caregivers
targeted population
with 1-12 year old children
with observed Special Study 30 (2004) 75
practicing appropriate
healthy practices is
personal and food hygiene
increased

*Computed at 20 percent reduction from the baseline

STRATEGIES FOR 2011-2016

Local mass deworming integrated with other national programs such as mass treatment for filariasis
and schistosomiasis, DepEd and DSWDs CCT programs. Mass deworming should be carried out
for at least three consecutive years among the target population.
Deworming programs integrated with nationwide immunization campaigns, and on a regular or
routine basis, with other programs targeting children.
Advocacy, social preparations and mass media campaign that precede and support the mass
treatment schedules.
Personal hygiene and sanitation practices like hand washing, proper food preparation, proper
footwear practices and proper human waste disposal.
Provision of safe water and sanitation services.

Page | 59
5.2.1.1.2. Pneumonia and other Acute Respiratory Infections

Pneumonia and other acute respiratory infections (ARIs) remain a public health concern as one of the
top ten leading causes of morbidity and mortality in the Philippines. Pneumonia ranked second among
the causes of morbidity in 2010 and fourth among the causes of death in 2005. Mortality due to
pneumonia is highest in Western Visayas, Ilocos and Cagayan and lowest in ARMM, Central Mindanao
and Western Mindanao (Department of Health, 2012). Acute respiratory infection is the most common
cause of morbidity in 2010 (Department of Health, 2012).

The death rate from pneumonia among children under-five years of age declined significantly from
118.69 per 100,000 in the 1995 to 37.99 per 100,000 in 2005 as shown in Figure 29 (Department of
Health, 2005). The morbidity rate among under-five year old children went down from 5,076.17 per
100,000 in 2002 to 1,801.14 per 100,000 in 2010 (Department of Health, 2012). The 2008 NDHS
revealed that half of the children below five years of age who had the symptoms of acute respiratory
infection were taken to a health facility or health care provider for treatment. This is an 8 percent
reduction from the 58 percent reported in the 1998 NDHS. Forty-two percent of them were given
antibiotics (National Statistics Office, 2008).

FIGURE 29. TRENDS IN PNEUMONIA MORBIDITY AMONG UNDER-FIVE YEARS OLD,


PHILIPPINES, 1980-2005

450
400
Rate per 100,000 population

350
300
250
200
150
100
50
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

Source: Philippine Health Statistics 2005

The populations most vulnerable to developing fatal respiratory diseases are the very young, the elderly,
and the immuno-compromised. Children below five years of age have the highest risk, especially those
belonging to the middle to low economic classes because of their lower capacity to acquire basic needs.
Page | 60
Morbidity is also known to have adverse consequences on childrens growth and development, daily
activities, and school performance. The program aims to reduce mortality from pneumonia and other
acute respiratory infections.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Mortality from pneumonia and other acute respiratory infections is
reduced.
Strategic Latest
Indicator Data Source 2016 Targets
Objective Baseline

Mortality rate from


pneumonia per 100,000 DOH-PHS 23.3 (2005) 18.6*
Mortality from under five year old children
pneumonia among
children under 5 % Under five year old
years old is reduced children with symptoms of 50 (2008)
ARI who sought treatment NSO-NDHS 90
from a health facility or
health provider
Mortality from
Mortality rate from
pneumonia among
pneumonia per 100,000 60- DOH- PHS 569 (2005) 540
older persons is
year-old persons and older
reduced
Mortality from
pneumonia among Mortality rate from
the general pneumonia per 100,000 DOH-PHS 41.4 (2005) 33*
population is population
reduced.
* computed based on 20 percent reduction from the baseline

STRATEGIES FOR 2011-2016

CHT promotion of good hygiene and other preventive measures to prevent the transmission
of ARI through the CHTs
Surveillance and monitoring and evaluation
Timely and appropriate management for pneumonia.
Ensuring availability of essential IMCI drugs for children below five years of age at the local level.

5.2.1.1.3. Dengue

Dengue fever is a viral disease characterized by sudden onset of fever, headache, muscle and joint pain,
and rashes. It is potentially fatal especially when the more severe form, dengue hemorrhagic fever (DHF)
or dengue shock syndrome (DSS), develops. At present, there is no vaccine to prevent this disease.
Despite its risks, dengue has become rather commonplace in endemic tropical countries such as the
Philippines. However, with climate change and the rise of urbanization, the disease once associated with

Page | 61
the rainy season is beginning to change its pattern, and is proving to be an even more urgent year long
public health problem.

Figure 30 shows that between 2004 and 2007, dengue cases in the country steadily increased from 23,040
cases to a peak of 55,639 cases. In September 2009 it peaked again to 57,819 cases (World Health
Organization, 2010). The case fatality rate for dengue fever decreased from 1.17 percent in 2005 to 0.74
percent in 2010 (World Health Organization, 2010). The availability of funding enabled campaigns to run
all year long beginning in 2007, as compared to relegation of campaigns to the Dengue Awareness Month
in previous years.

FIGURE 30. TRENDS IN DENGUE CASES AND CASE FATALITY, PHILIPPINES, 2000-2010

70000 5
4.5
60000
4
50000
Number of cases

3.5
3

Percent
40000
2.5
30000 2
20000 1.5
1
10000
0.5
0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Number of Dengue Cases CASE FATALITY RATIO

Source: WHO DengueNet Database, 2011

The vector easily proliferates in congested urban areas where access to water and sanitation is poor, and
residents are constrained to adopt various water storage practices. Additional risk factors for dengue
hemorrhagic fever include immune status and type of infecting virus. Persons previously infected with
one or more types of dengue virus are thought to be at greater risk for developing DHF if infected again
(US Army Public Health Command, 2010). Acute Hemorrhagic Fever (Dengue Hemorrhagic Fever)
cases were high in Davao, Zamboanga Peninsula, Cagayan Valley and CALABARZON in 2009
(Department of Health, 2009).

An affected individual may lose up to ten days of school or work due to ambulatory or hospital care.
Similarly, caretakers must devote work hours to patient care. Economic productivity is further reduced by
direct and indirect costs including medication, hospital care, and income lost by the household due to

Page | 62
illness. Moreover, national interest is compromised by dengue outbreaks that discourage tourists (Suaya,
Shepard, & Beatty, 2006).

The Dengue Control Program works to lower the incidence of dengue fever in the country by
intensifying its advocacy on vector control and by redirecting its focus to school children. The success of
the program relies on changing behaviors and targeting young persons may result in good preventive
habits. Educating those most at risk prevents disease and its more severe forms. With the help of
agencies operating within schools, the morbidity and mortality of dengue will decrease.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Reduction of morbidity and mortality from dengue infection

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets

Morbidity from
Incidence of dengue WHO-
dengue infection is
cases per 100,000 DengueNet 0.6 (2009) <0.6
reduced
population Database
Mortality from WHO-
% Dengue case
dengue fever is DengueNet 0.9 (2009) < 0.9
fatality rate
reduced Database

STRATEGIES FOR 2011-2016

Timely mass media and community-based information campaigns on dengue control.


Early diagnosis and quality clinical care for dengue cases at all levels of care. This is achieved by continuing the
training of clinic-based and hospital-based health care providers and improving the case referral networks.
Risk-reduction interventions such as environmental sanitation and removal of mosquito breeding places, specifically
during the peak season for the disease.

5.2.1.1.4. Food-borne and Water-borne Diseases

Food-borne and water-borne diseases are usually manifested as diarrhea, which is second to pneumonia
as the leading cause of morbidity in the Philippines. At present, both the Field Health Services
Information System (FHSIS) and the Philippine Health Statistics (PHS) show a generally decreasing trend
in the morbidity rate of diarrhea. PHS shows a decrease from 759.3 cases per 100,000 population in 2003
to 716.4 per 100,000 population in 2005 (Department of Health, 2005). However, the mortality rate
slightly increased from 5.3 per 100,000 population in 2003 to 6.1 per 100,000 population in 2005
(Department of Health, 2005) (see Figure 31).

Page | 63
FIGURE 31. TRENDS IN DIARRHEA MORBIDITY AND MORTALITY, PHILIPPINES, 1980-2005

2500 35
30
Morbidity rate per 100,000 population

2000

Mortality rate per 100,000


25
1500 20

1000 15

10
500
5

0 0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
MORBIDITY MORTALITY

Source: Philippine Health Statistics, 2005

Several notable outbreaks of food and water-borne diseases occurred in 2008. There were a total of 2,500
typhoid cases and 800 cholera cases during that year (Department of Health, 1980-2010). Four hundred
thirty-six cases of acute bloody diarrhea (ABD) were reported from sentinel sites nationwide. Seventy-
seven hepatitis A cases and 79 cases of paralytic shellfish poisoning were also reported (Department of
Health, 2008).

This group of diseases is usually caused by infectious organisms like viruses, bacteria and parasites.
However, some forms are secondary to chemical food poisoning (which will be discussed separately
under the environmental health hazards). These diseases are transmitted from person to person via soiled
hands and via food and water contaminated by human waste through the oral-fecal route. The incidence
of food-borne and water-borne diseases peaks during the rainy season and is usually high in areas where
sanitation and hygienic practices are poor.

The goal of the Food and Water-borne Diseases Prevention and Control Program is to reduce the
morbidity rate and eliminate deaths due to diarrhea. The program also aims to reduce the number of all
typhoid, paratyphoid, and cholera outbreaks to one per year. Since the occurrence of food and water-
borne diseases is essentially related to economic and socio-cultural factors, the program recognizes that
outbreaks will persist unless underlying social ills are corrected. Along with poverty comes the prevalence
of infectious diseases. However, if specific interventions are employed, a drastic reduction of bacterial
and parasitic infections can also be expected.

Page | 64
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOALS:
Morbidity and mortality from food-borne and water-borne diseases are reduced.
Outbreaks of food-borne and water-borne diseases are reduced.

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective

Morbidity and Morbidity rate from 288.7 (2010)


diarrhea per 100,000 DOH-FHSIS 230
mortality rates due
population
to food-borne and
water-borne
Mortality rate of 6.1 (2005)
diseases are
diarrhea per 100,000 DOH-PHS No deaths
reduced
population

Number of typhoid, 2008 data:


Number of FWBD
paratyphoid and Cholera: 800 cases
outbreaks is DOH Surveillance Zero outbreak per
cholera cases as
reduced or Report year
confirmed by the Typhoid: 2,500
eliminated
DOH cases

STRATEGIES FOR 2011-2016


Regulate and monitor food and water sanitation practices at the local level through enforcement of
national and local legislations, application of appropriate technical standards and participation of
non-government agencies.
Sustain inter-agency collaboration to fast-track sanitation infrastructure development in poor urban
areas and in rural areas with low access to safe water and sanitation facilities.
Promote personal hygiene, food and water sanitation practices and the principles of environmental
health.
Promote the use of ORS in the management of diarrhea to prevent dehydration, especially among
infants and children.
Promote breastfeeding and other good feeding practices for infants and children
Continue training of health personnel in the early diagnosis and treatment of food-borne and water-
borne diseases
Continue nationwide information campaign for the prevention and control of food-borne and water-
borne diseases.

5.2.1.1.5. Dental and Periodontal Infections

Oral health is an essential component of general health, and is a major determinant of the quality of life.
Unfortunately, oral disease continues to be a serious public health problem in the Philippines. Dental and
oral diseases create a silent epidemic, placing a heavy burden on Filipino schoolchildren.

The 2006 National Oral Health Survey (NOHS) revealed that 97.1 percent of six-year-old and 82 percent
of 12-year-old children suffer from tooth decay. More than four out of every five children of this
Page | 65
subgroup manifested symptoms of dentinogenic infection. In addition, 78.4 percent of twelve-year-old
children suffer from dental caries and 49.7 percent of the same age group manifested symptoms of
dentinogenic infections (Department of Education, 2006). The severity of dental caries, expressed as the
average number of decayed teeth indicated for filling/extraction or filled permanent or temporary teeth
(DMFT) was 8.4 DMFT for the six-year-old age group and 2.9 DMFT for the twelve-year-old age group
(Department of Education, 2006).

FIGURE 32. PROPORTION OF ORALLY FIT CHILDREN (12-71 MOS OLD)


BY REGION, PHILIPPINES, 2010
Filipinos bear the burden
ARMM of gum diseases early in
Caraga
SOCCSKSARG
their childhood.
Davao According to the 2010
Northern
Zamboanga
FHSIS Report, the
Eastern Visayas proportion of orally fit
Central Visayas
Western
children is only 17 percent
Bicol with the highest at
MIMAROPA
CALABARZON
Cagayan Valley (34
Central Luzon percent) and lowest in
Cagayan Valley
Ilocos Davao Region (6 percent)
CAR (see Figure 32). On the
NCR
other hand, 74 percent of
0 5 10 15 20 25 30 35 40
twelve-year-old children
Source: Field Health Service Information System, 2010
suffer from gingivitis
(Department of Education, 2006). Poor oral health poses detrimental effects on school performance and
on success in later life. In fact, children who suffer from poor oral health are 12 times more likely to have
restricted-activity days (US Government Accountability Office, 2000). In the Philippines, toothache is a
common ailment among schoolchildren, and is the primary cause of absenteeism from school (Araojo,
2003). If not treated early, these children become susceptible to irreversible periodontal disease as they
enter adolescence and approach adulthood.

In general, tooth decay and gum diseases do not directly cause disability or death. However, these
conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially
dangerous systemic diseases and infections. Serious conditions include arthritis, heart disease,
endocarditis, gastro-intestinal diseases, and ocular-skin-renal diseases. Aside from physical deformity,
these two oral diseases may also cause disturbance of speech significant enough to affect work
performance, nutrition, social interactions, income, and self-esteem.
Page | 66
The program therefore aims to reduce the prevalence rate of dental caries and periodontal disease to
improve the oral health not only of children but of the general population.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: The oral health of the general population is improved.

Strategic Indicator Data Source Latest Baseline 2016 Targets


Objective
National Monitoring
97
and Evaluation 71.3
(6 years old) (2006)
Prevalence of % Prevalence rate Dental Survey
dental caries is of dental caries (NMEDS) or
82
reduced National Oral Health 60.28
(12 years old)
Survey for Children
(2006)
(NOHS)
% Prevalence rate
Prevalence of
of gingivitis among
periodontal disease NMEDS or NOHS 74 (2006) 54.4
12 year old
is reduced
children
The proportion of
Orally Fit Children % Orally Fit
(OFC) 12-71 Children 12-71 DOH- FHSIS 17 (2010) 5*
months old is months old
increased
*computed at 20 percent reduction annually from the baseline

STRATEGIES FOR 2011-2016


Formulate policy and regulations to ensure the full implementation of OHP. Develop standards for
oral health services.
Expand the Oral Health Program to include other age groups
Explore the development of an outpatient benefit package for oral health. Develop financing
schemes for oral health applicable to other levels of care (fee for service, cooperatives, network with
HMOs).
Provide adequate dental personnel and build up highly motivated health professionals and trained
auxiliaries to manage and provide quality oral health care
Ensure delivery of quality oral health services. Upgrade dental services unit at all levels of care
Provide relevant, timely and accurate information management system for Oral Health and enhance
existing system of reporting and recording forms
Design and implement grant assistance mechanism for high performing LGUs (Awards and
incentives) or identify areas for priority assistance.

5.2.1.2. Diseases for Elimination

5.2.1.2.1. Rabies

The Philippines has consistently ranked among the top 10 countries with human rabies death. Rabies is
one of the most acute of fatal infections. It is the cause of 200 to 300 deaths reported each year, more
than half (59.3 percent) of which are children under 15 years old (National Statistics Office, 2008). In
Page | 67
2008, the top six provinces with the most number of human rabies cases include Isabela, Camarines Sur,
Cagayan, Nueva Ecija, Iloilo, and Camarines Norte (Department of Health, 2008).

The number of animal bite victims increased in the past five years as shown in Figure 33, with 216,569
cases reported in 2009 (Department of Health, 1980-2010). Fifty-nine percent was recorded in Luzon, 24
percent in Visayas, and 17 percent in Mindanao (Lopido). However, rabies cases in the country have
significantly decreased in the past few years. In 2005, the Department of Health registered a total of 440
rabies cases nationwide (Department of Health, 1980-2010). In 2008, the figure dropped to 248, posting a
43 percent difference in a span of 3 years. The mortality rate due to rabies also decreased from 0.9 per
100,000 population in 2000 to 0.5 per 100,000 population in 2005 (Department of Health, 2005).

FIGURE 33. TRENDS IN ANIMAL BITE VICTIMS AND RABIES CASES, PHILIPPINES, 1995-2010

300,000 800
700
250,000
600

Number of Rabies cases


Number of victims

200,000
500
150,000 400
300
100,000
200
50,000
100
0 0
1995199619971998 199920002001200220032004 200520062007200820092010

Animal Bite Victims Mortality Rabies Cases

Source: PHS, 2005 and National Center for Disease Prevention and Control, DOH, 2010

Rabies poses economic burdens to the victims and the country. The highest financial expenditure is the
cost of rabies post-exposure prophylaxis. In addition to the expense of rabies biologicals are the
expenditures for physician and hospital, the loss of income as a result of a physical visit to a clinic, and
the emotional and psychological impact of post-exposure prophylaxis.

The goal of the National Rabies Prevention and Control Program is to eliminate human rabies in the
Philippines and to declare the country rabies-free by the year 2020. As of 2010, there are five areas
declared as rabies-free (Siquijor, Batanes, Camotes Island, Apo Island and Malapascua Island)
(Department of Health, 1980-2010).

Page | 68
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: To eliminate rabies and declare the Philippines Rabies-free by 2020.
(Rabies is eliminated as a public health problem at less than 0.5 cases per million population)

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objectives
Number of deaths Mortality rate from
due to rabies is rabies per 1,000,000 NSO 2.8 (2008) Less than 1 .5
reduced population

PEP completion rate % Post-Exposure DOH


among cases is Prophylaxis (PEP) -Program report <70 (2008) 90
increased completion - PEP registry

% Rabies DOH
RIG coverage is 25 (2008)
Immunoglobulin -Program report 40
increased
(RIG) coverage - PEP registry
Percentage of animal
bite victims that DOH
% Bite victims who
practice washing of -Program report
washed the bite site 37 (2008) 90
bite sites with soap - PEP registry
with soap and water
and water is
increased
Number of rabies-
Number of rabies- DOH Program 5
free areas is 10
free areas report (2010)
increased

STRATEGIES FOR 2011-2016

Ensure rabies exposed patients have access to Post-Exposure Prophylaxis (PEP)


Ensure rabies exposed patients receiving PEP complete the recommended PEP regimen
Intensify social and behavioral change communication campaign on Responsible Pet Ownership (RPO)
and on the immediate and proper management of animal bites.
Collaborate with all stakeholders to improve dog vaccination coverage

5.2.1.2.2. Leprosy

Since 1998, the national prevalence rate of leprosy has consistently been less than one per 10,000
population. However, the Philippines has the highest prevalence of leprosy among the countries in the
Western Pacific Region. In 2010, the prevalence rate of leprosy is 0.46 percent (4,737 total cases), higher
than the rate in 2008 (Department of Health, 2008) (see Figure 34). Less than 2 percent of the cases
have Grade 2 deformities (Department of Health, 2008). The number of new cases have been fluctuating
within the last 5 years, with a decline in 2007 but increasing in 2009 and 2010. The regions with the
highest prevalence of leprosy are Eastern Visayas, Ilocos, Zamboanga Peninsula, Central Visayas and
Northern Mindanao (see Figure 35).

Page | 69
FIGURE 34. TRENDS IN PREVALENCE AND CASE DETECTION RATE OF LEPROSY,
PHILIPPINES, 1986-2010

8
7
6
5
4
3
2
1
0
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Case Detection Rate per 100,000 population Prevalence Rate per 10,000 population

Source: CDR source is DOH; prevalence rate computed from FHSIS and WHO WER

FIGURE 35. LEPROSY CASES BY REGION PHILIPPINES, 2010

ARMM

Caraga

SOCCSKSARGEN

Davao

Northern Mindanao

Zamboanga

Eastern Visayas

Central Visayas

Western Visayas

Bicol

MIMAROPA

CALABARZON

Central Luzon

Cagayan Valley

Ilocos

CAR

NCR

0 200 400 600 800 1000 1200 1400 1600 1800

Source: Field Health Service Information System, 2010

Page | 70
Leprosy brings about several problems lowered quality of life and psycho-socio-economic burdens to
the patient, the family and the community. These are compounded by social stigma, discrimination and
human rights issues. In effect, finding of new cases becomes more difficult, thereby hindering utilization
of free Multiple Drug Therapy (MDT) in the Rural Health Units. Spreading awareness about the disease
and treatment is the next challenge for the Leprosy Program in order to eliminate leprosy as a public
health problem in endemic areas and to achieve the goal of a leprosy-free country. The main goal of
the program is to sustain the low prevalence status, to develop strategies for early detection at the
subnational level, to treat current cases to prevent further disability, to screen contacts to reduce stigma
and discrimination, and to help restore dignity to those affected.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Leprosy is eliminated as a public health problem in endemic areas
(Leprosy is eliminated as a public health problem at a level of one case per 10,000 population)

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
% Prevalence rate of DOH Program
0.35 (2008) <0.35
leprosy report

2008 data:

Number of endemic Province 5;


DOH-FHSIS 7 endemic areas
provinces
Leprosy in endemic City 4;
areas is eliminated Municipality 6;

DOH Program
% Case detection rate 2.47 (2008) 1.8
report

% Treatment DOH Program


85 (2008) 90
completion report

STRATEGIES FOR 2011-2016


Ensure the availability of adequate anti-leprosy drugs or multiple drug therapy (MDT) nationwide
through the DOH as these are not available in the market.
Prevent and reduce disabilities from leprosy through Rehabilitation and Prevention of Impairments
and Disabilities (RPOID). This entails capability building of health workers in quality diagnosis and
case management of leprosy cases, including the prevention and management of impairments and
disabilities.
Improve case detection and post-elimination surveillance system using the WHO protocol in all
LGUs targeted for leprosy elimination and in areas where elimination (less than one case per 10,000
population) has been achieved. This will ensure timely reporting and recording of leprosy cases as
well as quality monitoring and evaluation at all levels.
Integrate leprosy control in other health services at the local level especially in endemic areas.
Strengthen collaboration with partners and other stakeholders in the provision of services and for
social mobilization and advocacy activities for leprosy.

Page | 71
5.2.1.2.3. Filariasis

Lymphatic Filariasis (LF) puts at risk more than a billion people in 83 countries and affects more than
120 million people globally, with over one-third becoming severely disfigured and disabled. In the
Philippines, 43 out of 80 provinces are endemic for the disease, with over 28 million people living in
these areas (Department of Health, 1980-2010). Majority of those affected are the marginalized groups
living in remote, rural, and oftentimes inaccessible areas. The endemic provinces are classified and are
identified based on the elimination level set by the WHO, which are: a microfilaria rate (MFR) of less
than 1 percent; and an antigen rate of less than 1 percent per Implementing Unit (IU).

FIGURE 36. FILARIA ENDEMIC PROVINCES, PHILIPPINES, 2010

Filarial-Free Areas, Philippines, 2010 The use of mass drug administration (MDA) in
eliminating the disease has so far been effective in
some provinces such as Southern Leyte, Sorsogon,
Biliran, Bukidnon, Romblon, Agusan del Sur and
Dinagat Island. The success in these areas is mainly
due to the collaboration of health professionals,
community health workers, local government units,
and other sectors who worked together to implement
the program. However, majority of the endemic
provinces still have not reached the target MDA
coverage rate of 85 percent, with most only achieving
a coverage rate of 60 percent (Department of Health,
1980-2010). This is mainly due to the lack of
awareness and understanding about LF and its
elimination.
Filariasis was a neglected disease in the past. But,
with the global call for eliminating filariasis as a

Source: National Center for Disease Prevention and Control,


public health problem, the DOH heeded and
DOH, 2010 responded. The primary goal of the National
Filariasis Elimination Program (NFEP) is for LF to be eliminated as a public health problem by 2015.
This is considered to be accomplished when the prevalence rate of microfilaremia is less than 1 percent.
Similarly, the program aims to control and reduce the morbidity by alleviating the sufferings and disability
caused by the diseases clinical manifestations.

Page | 72
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Elimination of filariasis as a public health problem through a
comprehensive approach and universal access to quality health services

Strategic Latest
Indicator Data Source 2016 Targets
Objectives Baseline
Number of
provinces that have DOH Program
7 (2010) 12
reached elimination report
Filariasis in endemic level
areas is eliminated % Mass Drug
administration DOH Program
70 (2009) 85
Coverage (MDA report
Coverage)
Disability Number of LF
management and patients with
All validated LF
prevention for chronic
DOH Program patients provided
patients with complications To be determined
report disability
chronic provided with
management
complications is disability
implemented management

STRATEGIES FOR 2011-2016

Strengthen surveillance system to quickly identify other endemic areas and sustain elimination status
of provinces/cities that have reached elimination level
Sustain coverage of MDA in all established endemic provinces/cities to at least 85 percent
Ensure provision of quality services to include MDA drugs
Integrate training on disability prevention with leprosy
Strengthen program performance by empowering LGUs for a community-based implementation
Implement Integrated Vector Management

5.2.1.2.4. Schistosomiasis

Schistosomiasis remains to be a public health burden in endemic provinces in the Philippines.


Worldwide, an estimated 207 million people living in 74 countries are infected by Schistosoma spp., about
120 million of whom are symptomatic. It causes severe disability to about 20 million people and an
estimated 280,000 deaths each year (L. Chitsulo, 2000). S. japonicumis known to be endemic in China,
Indonesia, and the Philippines (L. Chitsulo, 2000).

In the Philippines, the 2008 National Prevalence Survey revealed a national prevalence of 2.5 percent
(Department of Health, 2008). In 2008, the morbidity rate due to schistosomiasis, by passive surveillance,
has risen to 10 percent from 6.6 percent of the previous year (Department of Health, 2008). The survey
also shows that more males than females are affected with a male to female ratio of 1.7 and a prevalence
rate peaking at 15 to 49 years of age (Department of Health, 2008). Distribution of schistosomiasis is
influenced by the presence of the snail intermediate host, environmental sanitation, access to safe water,
Page | 73
health services, and local infrastructure factors often associated with poverty (Huang & Manderson,
2005). Similarly, the source of livelihood affects the disease distribution.

FIGURE 37. SCHISTOSOMIASIS ENDEMIC PROVINCES, PHILIPPINES, 2010

Schistosomiasis is endemic in twelve (12) regions


covering 28 provinces, 190 municipalities and 20
cities as shown in Figure 37 (Department of Health,
1980-2010). Two additional municipalities:
Gonzaga, Cagayan (Region 2) and Calatrava, Negros
Occidental (Region 6) were recently identified as
schistosomiasis endemic areas in 2004 and 2006,
respectively, through identification of indigenous
cases and infected Oncomelania hupensis quadrasi snail
vector (Velasco, et al., 2005) (Department of Health,
2007).

In high to moderate endemic provinces, the goal is


to eliminate morbidity through mass chemotherapy

of the exposed population (ages 5-65) to progressively


Source: Department of Health 2010
reduce the prevalence of schistosomiasis to less than one percent.
On the other hand, in areas within the elimination levels of below 1 percent, gains must be sustained
through strengthened active surveillance of human and snail vectors, infection control (treatment of all
cases found), transmission control (sanitation and hygiene along with improve access to health facilities,
safe water supply, water sealed toilets, ordinances to control animal hosts), mass treatment of school
children, and quality control of laboratory and laboratory staff.

Page | 74
NATIONAL OBJECTIVES 2011-2016
OVERALL GOAL: Schistosomiasis is eliminated as a public health problem in all endemic
provinces (Schistosomiasis is considered eliminated as a public health problem if the prevalence rate is
reduced to less than 1 percent for at least five consecutive years)

Data Latest
Strategic Objective Indicator 2016 Targets
Source Baseline
% Prevalence rate of Special
Schistosomiasis in 2.5 (2008) <2.5
schistosomiasis Survey
endemic areas is
eliminated Number of provinces DOH
that have reached Program 0 (2010) 5
elimination level report
% Coverage in mass
Coverage of mass DOH
treatment of exposed To be
treatment is increased in Program 85
population (5-65 years determined
endemic provinces report
old)

STRATEGIES FOR 2011-2016

Shift from control to elimination strategies. The progress of the schistosomiasis elimination program
will be demand-driven and depends highly in the commitment of communities and local
governments.
Develop the capacity of local health personnel and stakeholders in the elimination of schistosomiasis
and improve the implementation of schistosomiasis initiatives through building of networks and
linkage with collaborating institutions and program partners.
Ensure the availability of reliable information, financial support and logistics crucial to
schistosomiasis elimination through collaboration with other national agencies and international
donors.
Secure presidential directives, local legislation and international support necessary to eliminate
schistosomiasis from the country.
Intensify surveillance of human cases and surveillance of snail vector through environmental
mapping of areas with positive snail colonies. Conduct of rapid epidemiologic surveys in response to
suspected cases in new areas.

5.2.1.3. Emerging and Re-emerging Infections

The surge of infectious diseases has remained over the years as one of the leading causes of death and
disability worldwide. It continues to pose a major challenge to human progress and survival. Outbreaks of
new and old infectious diseases sporadically emerge, magnifying the global burden of infections. Emerging
infections are newly identified or drug-resistant infections whose incidence in humans has increased within
the past two decades, or whose incidence or geographic range threatens to increase in the near future. Re-
emerging infections are those that have resurged secondary to the reappearance of a (previously) known
infectious disease.

Page | 75
In the past five years, the A(H1N1) virus was the only major emerging infection witnessed in the Philippines.
Despite the high number of fatality and contact cases reported in other countries, the Philippines remained
relatively swine flu-free. With a total of 5,212 A(H1N1) cases monitored in the country in 2009, the countrys
case fatality rate was 0.6 percent, remaining well below the global case fatality rate which was at 1.2 percent
(Department of Health, Various years).

The Ebola Reston Virus emerged in pigs from the last quarter of 2008 until the first quarter of 2009
(Department of Health, Various years). Surveillance studies were carried out in Pangasinan and Bulacan,
where most of the animal cases had been reported. Studies revealed that a number of people had been
infected; however, none of them presented any signs of illness.

Cases of Meningococcimea and Japanese Encephalitis have also been reported in some areas. These
infections have thus far remained endemic to certain areas and have not caused disease outbreaks. On the
other hand, the country witnessed a leptospirosis epidemic outbreak after Typhoon Ondoy hit the Philippines
on September 2009. Leptospirosis cases went up to 4,326 in two months after the typhoon, reaching an
average of 65 cases of hospital admissions in a day until the end of November (Department of Health,
Various years).

The inherent unpredictability of emerging and re-emerging infections creates a gap between planning and
concrete action. The programs policies can only be implemented once a disease has been identified; even
then, the program can only be proactive to the extent of preparedness. The rest of the time, the program
remains reactive, able to devise an attack plan only when the disease has arrived.

As in most developed countries, infectious disease problems are related to changing lifestyles, technical
advancements that lead to increased susceptibility to infectious disease agents, incomplete immunization
programs resulting in changes in the age distribution of susceptible population, and emergence of new agents
of disease. The program needs to monitor factors that contribute to the spread of diseases, such as human
demographics and behavior, technology and industry, economic development and land use, international
travel and commerce, microbial adaptation and change, breakdown of public measures, and human
vulnerability.

Page | 76
NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Emerging and re-emerging infections are reduced.

Strategic Objective Indicator Data Source Latest Baseline 2016 Targets


Avian flu case fatality
Death or casualty from any DOH
% Case rate: 0
emerging and re-emerging surveillance 0
fatality ratio Influenza A(H1N1) case
infections are prevented. report
fatality rate: 0.6 (2009)

STRATEGIES FOR 2011-2016


Isolate all cases of emerging and re-emerging infections
Contact tracing and quarantine for any emerging and re-emerging infection are implemented
Pre-emptive planning and organizing at national, regional, provincial, city or municipal levels to
ensure preparedness for emerging infections with potential for causing high morbidity and mortality,
with efforts to integrate prevention and control measures that are applicable for Avian flu, A(H1N1)
and other emerging infections.
Integrate surveillance of emerging infections with existing surveillance systems for other diseases.
Train adequate health personnel of the national and local governments and other partner
organizations for surveillance, response and management of diseases outbreaks.
Secure adequate resources and develop systems to mobilize these efficiently when outbreak occurs.

5.2.2. PREVENTION AND CONTROL OF NON-COMMUNICABLE DISEASES


Infectious and pregnancy-related morbidities are still major health problems in the country. However, there is
a noticeable epidemiologic shift from infectious to non-communicable diseases (NCDs) over the years (see
Figure 38). NCDs are a broad classification of medical conditions which are non-infectious in nature. In
general, they have relatively slow and long prognosis compared to infectious diseases.

FIGURE 38. MORTALITY TRENDS OF COMMUNICABLE DISEASES, MALIGNANT NEOPLASM AND


DISEASES OF THE HEART: NUMBER & RATE/100,000 POPULATION, PHILIPPINES, 1955-2005

600

500
Percentage in the population

400

300

200

100

Year

Communicable Diseases Malignant Neoplasms Diseases of the Heart

Source: Philippine Health Statistics, 2005


Page | 77
In 2005, seven of the ten leading causes of death were non-communicable in etiology. The death rates
from malignant neoplasm and diseases of the heart have continued to increase through the years while the
cumulative death rate from infectious causes has been decreasing over time (Department of Health, Various
years). The continuous dominance of NCDs as the leading cause of death is expected to continue in the next
few years.

5.2.2.1. Lifestyle-related diseases

The surge of chronic lifestyle-related non-communicable diseases (LRNCD) in the Philippines is no longer a
looming epidemic but a real one. In fact, 90 percent of adult Filipinos have at least one or more risk factors
for cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, and cancers (Food and Nutrition
Research Institute).

While the Philippines continue to suffer the double burden of communicable and non-communicable
diseases, the number of deaths and disabilities due to LRNCDs are far greater than those due to infectious
and parasitic diseases. In 2005, 49.9 percent of total deaths were caused by LRNCDs, with diseases of the
heart and vascular system constituting almost one-third (30.8 percent) of all deaths across the nation
(Department of Health, 2005). Unless an integrated and comprehensive response is established in local
communities, LRNCDs will persist as a major burden to the countrys public health.

LRNCDs are linked by common risk factors. These risk factors include tobacco use, unhealthy diet, physical
inactivity, and alcohol use. The close association among risk factors provides the Department of Health an
opportunity to prevent LRNCDs through interventions against these modifiable behavioral risk factors.
Recent evidence supports that the prevention of these risk factors is the most cost-effective way of
controlling these diseases. A successful public health program aimed at the elimination of these risk factors is
presumed to decrease the prevalence of heart disease, stroke, and type-2 diabetes by 80 percent and prevent
over 40 percent of cancer cases across the nation (Department of Health, 2009).

The causes of NCDs are multi-factorial in nature. However, majority of NCDs have malleable risk factors
that are highly related to lifestyle. Diet interventions among adults are advocated primarily for the control of
cardiovascular diseases and diabetes mellitus. Obesity prevalence among the different age groups is on the
rise as shown in Table 22. Obesity among adults aged 40 to 59 years old and older persons aged 60 years old
and above is 6.6 percent and 5.2 percent respectively (Food and Nutrition Research Institute, 2008).

Page | 78
TABLE 22. COMPARATIVE DATA ON OBESITY AMONG DIFFERENT AGE GROUPS, PHILIPPINES, 2008

Nutritional Status
Age Groups
(% Obese)
Children 0-5 years old 2.0
Children 6-10 years old 1.6
Adolescents 11-19 years old 4.6
Adult 20-39 years old 4.5
Adult 40-59 years old 6.6
Older persons 60 years old and over 5.2
Source: National Nutrition Survey, FNRI, 2008

The National Nutrition Survey of 2008, as shown in Table 23, revealed that the mean total cholesterol of
Filipino adults is still within normal levels but has increased from 159.2mg/dl in 1998 to 186.8mg/dl. The
proportion of adults with high cholesterol level (over 240mg/dl) increased from 4 percent in 1998 to 10.2
percent in 2008 (Food and Nutrition Research Institute, 2008). The percentage of adults with high
triglycerides level (400mg/dl) increased drastically from 0.8 percent in 1998 to 14.6 percent in 2008 (Food
and Nutrition Research Institute, 2008). The mean fasting blood sugar (glucose) or FBS level of Filipinos
slightly increased from 87.9mg/dl in 1998 to 88.1mg/dl in 2008 (Food and Nutrition Research Institute,
2008). Adults with high FBS level of more than 125mg/dl increased from 3.9 percent in 1998 to 4.8 percent
in 2008 (Food and Nutrition Research Institute, 2008).

TABLE 23. PREVALENCE OF NUTRITIONAL RISKS AND BLOOD EXAMINATION PARAMETERS RELATED
TO DEGENERATIVE DISEASES, PHILIPPINES, 2008

Nutritional Risk
Blood Examination 1998 2003 2008
Parameters

High Total Cholesterol 4.0 8.5 10.2


High LDL Cholesterol 2.0 11.7 11.8
Low HDL Cholesterol 65.4 54.2 64.1
High and Very High
0.8 0.7 14.6
Triglycerides
High Fasting Blood
3.9 3.4 4.8
Sugar Levels
Source: National Nutrition Survey, FNRI, 1998, 2003 and 2008

The intake of vegetable per capita per day has slightly decreased from 111 g/day in 1987 to 110 in 2008
(Food and Nutrition Research Institute, 2008) (see Table 24). However, the consumption of fruits has
decreased drastically from 107 g/day in 1987 to only 54 g/day in 2008 (Food and Nutrition Research
Institute, 2008). This means that the information and education campaigns have not resulted to
improvements in the consumption of vegetables and fruits through the years. Tobacco smoking and alcohol
intake shall be discussed more thoroughly under the section on substance abuse.
Page | 79
TABLE 24. PER CAPITA VEGETABLES AND FRUITS INTAKE PER DAY, PHILIPPINES, 1987, 1998 AND 2003

Food Taken 1987 1998 2003 2008


Vegetable
(g/per day) 111 106 111 110
Fruits
107 77 54 54
(g/per day)
Source: National Nutrition Surveys, FNRI, 1987, 1998 and 2003

5.2.2.1.1. Heart Disease and Diseases of the Cardiovascular System

The mortality rate from Heart Disease and Diseases of the Vascular System has been increasing through
the years as shown in Figure 39 with mortality rates in 2005 reaching 90.4 and 63.8 deaths per 100,000
population respectively (National Statistics Office, 2008). In the span of 10 years, the prevalence of
hypertension has increased 20 percent from its rate in 1998 (National Statistics Office, 2008) (see Figure
40).

FIGURE 39. TRENDS IN HEART DISEASE AND DISEASES OF THE VASCULAR SYSTEM MORTALITY,
PHILIPPINES, 1980-2005

100
90
80
70
60
Percentage in the population

50
40
30
20
10
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

Year

DISEASES OF THE HEART MORTALITY RATE DISEASES OF THE VASCULAR MORTALITY RATE

Source: Philippine Health Statistics, 1985 to 2005

Page | 80
FIGURE 40. TRENDS IN THE PREVALENCE OF HYPERTENSION, PHILIPPINES, 1993-2008

30

25

Percentage in the population 20

15

10

0
1993 1998 2003 2008

Source: National Nutrition Survey, 2008


5.2.2.1.2. Diabetes Mellitus
In 2008, the prevalence of diabetes mellitus among adults, as indicated by the high fasting blood sugar,
has increased 23 percent since 1998 (Food and Nutrition Research Institute, 2008) (Table 25).

TABLE 25. PREVALENCE OF HIGH FASTING BLOOD SUGAR (FBS)


AMONG ADULTS, PHILIPPINES, 1993, 2003 AND 2008
Figure 41 shows the mortality
% Prevalence of High Fasting Blood
Year rate from DM increased
Sugar
1998 3.9 significantly. From 9.8 deaths per
2003 3.4 100,000 population in 1995, it
2008 4.8 almost doubled to 18.1 deaths per
Source: National Nutrition Survey, FNRI, 1998 2003 and 2008 100,000 population in 2005
(Department of Health, Various years). The prevention and control of the different risk factors in the
development of this disease should be intensified and persons with a family history of diabetes mellitus
should undergo lifestyle modification.

FIGURE 41.TRENDS IN DIABETES MELLITUS MORTALITY PER 100,000 POPULATION, PHILIPPINES, 1980-2005

Page | 81
5.2.2.1.3. Chronic Obstructive Pulmonary Diseases (COPD)

The mortality trend for COPD has slowly increased from 12.3 deaths per 100,000 population in 1980
to 24.6 deaths per 100,000 in 2005 (Department of Health, Various years) (see Figure 42). It is one of
the diseases related to tobacco use. This may continue to increase if the risk factors for this disease
remain unabated.

FIGURE 42. TREND IN COPD MORTALITY, PHILIPPINES, 1980-2005


30
Rate per 100,000 population

25
20
15
10
5
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Source: Philippine Health Statistics, DOH, 2005

5.2.2.1.4. Malignant Neoplasm

Many different types of cancers have been identified. In 2005, the most common sites of reported deaths
from cancer in the Philippines are: trachea, bronchus and lung (8.5 deaths per 100,000 population);
breast (5.3 per 100,000); and colon (3.1 per 100,000) (Department of Health, 2005) (see Table 26).
Among males, the leading sites are the lungs, prostate, colorectal area and liver. Among females, the
leading sites are the breast, uterus, cervix and lungs. Among children, the leading cancers are the
leukemias and lymphomas.

TABLE 26. MORTALITY RATES OF LEADING CANCER SITES, PHILIPPINES, 2005


MORTALITY RATE*
RANK SITE OF MALIGNANT NEOPLASM
(PER 100,000 POPULATION)
1 Lung, trachea and bronchus 8.5
2 Breast 5.3
3 Colon 3.1
4 Leukemia 2.8
5 Lip, oral cavity and pharynx 2.4
6 Prostate 2.1
7 Stomach 1.7
8 Uterus 1.5
Lymphatic tissue 1.3
9
Cervix uteri 1.3
10 Malignant neoplasm of other female
1.2
genital organs
Source: *computed based on data from Philippine Health Statistics, DOH, 2005
Page | 82
The reported cases of malignant neoplasms have been increasing up to 1995 but an abrupt decrease in
the number of cases was noted in 1996 due to a change in the system of reporting (Figure 43).
Malignancies were removed among the notifiable diseases in the Field Health Service Information System
(FHSIS) in 2001. The morbidity rates have remained underreported thereafter. On the other hand, the
trend for reported deaths from all kinds of malignant neoplasms has been increasing over the years,
reaching 46.5 per 100,000 in the year 2005 (Department of Health, Various years).

FIGURE 43. TRENDS IN CANCER MORBIDITY AND MORTALITY, PHILIPPINES, 1980-2005

80

70

60
Mortality Rate per 100,000 population

50

40

30

20

10

0
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
Year

MORBIDITY RATE MORTALITY RATE

Source: Philippine Health Statistics, DOH, 2005

The Integrated Non-communicable Lifestyle-related Disease Prevention and Control Program envisions
to improve the quality of life for all Filipinos by ensuring that LRNCD quality prevention and
control services are accessible to all Filipinos, especially to the vulnerable and at-risk population. The
objectives of the program are: to reduce the exposure of population to risks related to LRNCDs; and to
increase the proportion of LRNCD cases given appropriate treatment and care. This will eventually lead
to the reduction of morbidity and mortality from lifestyle-related diseases and the improvement of the
quality of life of those who are suffering from such diseases.

Page | 83
NATIONAL OBJECTIVES FOR 2011-2016

OVERALL GOAL: Morbidity and mortality from lifestyle-related diseases are reduced
and the quality of life of those who are suffering from such diseases is improved.

Strategic Latest
Indicator Data Source 2016 Targets
Objective Baseline

Mortality rate from heart diseases


NSO-PSY 84.8 (2008) 75*
per 100,000 population
Mortality from
degenerative or Mortality rate from vascular
NSO-PSY 61.8 (2008) 55*
lifestyle-related diseases per 100,000 population
diseases is Mortality rate from diabetes
reduced. DOH-PHS 21.6 (2005) 19*
mellitus per 100,000 population
Mortality rate from COPD per
DOH-PHS 24.6 (2005) 22*
100,000 population
Mortality rate from all forms of
malignant neoplasm per 100,000 DOH-PHS 48.9 (2005) 43*
population
Morbidity from % Prevalence rate of raised blood
diseases of the FNRI-NNS 25.3 (2008) 22*
pressure
heart and vascular
system is % Prevalence of diabetes mellitus FNRI-NNS 4.8 (2008) <4.8
reduced.
Early detection
and screening for % Women 18-65 years old who
degenerative or have one Pap smear or visual DOH-NOH
8.8 (2010) 35
lifestyle-related acetic acid screening at least every Midline Survey
diseases are 3 years
increased.
% Prevalence rate of adults with
FNRI-NNS 4.8 (2008) 4.3 *
high fasting blood sugar
% Prevalence rate of high total
FNRI-NNS 10.2 (2008) 9*
serum cholesterol among adults
% Percentage of overweight and
FNRI-NNS 26.6 (2008) 23.5*
obese among adults
Risk factors
Mean population intake of salt per
associated with FNRI-NNS 3.3 (2008) <3.3
day in grams
lifestyle-related
diseases are Mean one-day per capita fruits and
reduced. vegetables intake in grams 1. FNRI-NNS
1. 54g (2008) 400 grams of fruits and
1. Fruits 2. WHO
2. 110g vegetables
2. Vegetables Report

% Prevalence of adults with high


FNRI-NNS 60.5 (2008) 50.8
physical inactivity

Page | 84
STRATEGIES FOR 2011-2016
Implement sound, long-term and sustained Healthy Lifestyle promotion programs using community-
based approaches, with DOH supplementing local campaigns with regular mass media campaigns and
CHED improving medical and paramedical curricula in the area of healthy lifestyle and behavior
modification.
- Promote information, education and advocacy campaigns in the reduction of risk factors, early
detection and management, and improvement in the quality of life of people with lifestyle-related
diseases.
- Expand the capacity of primary health care facilities on health promotion, screening, early diagnosis
and early management of LRDs.
Translate and implement provisions of the tobacco laws as local ordinances and develop community
infrastructure supportive of healthy lifestyle (sports centers, green parks, smoking cessation clinics, etc.).
Pursue training of clinicians and other frontline health care providers in health promotion, screening,
early diagnosis, treatment, rehabilitation and palliative care.
Support and implement financial risk protection measures for persons with lifestyle-related diseases by
lowering the cost of essential drugs and provision of better social health insurance benefit packages.
Other strategies:
- Manage risk behaviors and risk factors by establishing more smoking cessation clinics, finding and
treating more patients with rheumatic heart disease, providing more training opportunities for diet
counseling and smoking cessation programs, and organizing and counseling for healthful physical
activities.
- Strengthen networking and collaboration among GOs, NGOs and various stakeholders to ensure
sharing of technologies, resources and expertise and to maximize efforts towards the prevention and
control of lifestyle-related diseases.

5.2.2.2. Diseases of the kidney and the urinary tract

FIGURE 44.TRENDS IN KIDNEY DISEASE MORTALITY,


PHILIPPINES, 1980-2005
Mortality trends for diseases of the
14 kidney and urinary tract are
12
generally increasing (see Figure 44).
10
Mortality Rate per 100,000 population

8
Kidney diseases killed more than
6 11,000 Filipinos in 2005. It is the
4
tenth most common cause of
2

0
mortality in the country
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

(Department of Health, 2005).


Year

Nephritis, Nephrotic Syndrome and Nephrosis Kidney Infections Calculus of Kidney, Ureter and Lower Urinary Tract
The mortality rate for nephritis,
nephrotic syndrome and nephrosis
in 2005 was 13 deaths per 100,000
population (Department of Health, 2005). Kidney infections and calculi at any portion of the urinary tract
had mortality rates of 0.6 and 0.5 deaths per 100,000 population, respectively, during that same year
(Department of Health, 2005).
Page | 85
Among the kidney diseases, the most dreaded outcome is end-stage renal disease (ESRD), which requires
either lifetime dialysis or kidney transplant. Without any of the two, ESRD is fatal.

Both dialysis and kidney transplant cause significant morbidity and financial burden to the patient. Dialysis
involves being hooked up to a machine for a few hours for most days of the week while kidney transplant
involves immuno-suppression which makes the patient vulnerable to infections.

Despite this, the incidence and prevalence of ESRD continue to rise as reflected in the dialysis registry. The
prevalence of dialysis patients with ESRD is now 10,052, of which 7,589 are new cases identified in 2008
(Department of Health, 2008). However, it is important to note that these figures are only those captured by
the dialysis registry and does not include patients unable to seek medical attention to get the necessary
treatment or to directly undergo a kidney transplant. The real extent of ESRD in the country is still unknown.

ESRD cases must be prevented especially when caused by preventable causes like diabetes mellitus and
hypertension. The country must be knowledgeable of kidney diseases, their causes, signs and symptoms, and
preventive measures.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Morbidity and mortality from kidney diseases are reduced and the
quality of life of those who are suffering from such diseases is improved.

Strategic Latest
Indicator Data Source 2016 Targets
Objective Baseline
Deaths from kidney
Mortality rate from kidney 13.0
diseases are DOH-PHS 10
diseases per 100,000 population (2005)
reduced
Incidence of ESRD Incident cases per 100,000 Philippine Renal 8.39
4
is reduced population Disease Registry (2008)

STRATEGIES FOR 2011-2016


Integrate program on prevention of ESRD with the healthy lifestyle program of DOH
Promote healthy lifestyle (promote physical activity and maintenance of normal body weight, prevent
excesses in food, drinks and alcohol intake, and avoid smoking and substance abuse, etc.).
Strengthen research and development and renal disease information system towards identifying high
risk groups, preventable risk factors, effective preventive measures and behavioral influences for
early detection and successful case management.
Institute and campaign for better insurance benefit packages that are responsive to the needs of
ESRD patients.
Ensure collaboration and partnership among stakeholders in the prevention and control of kidney
and urinary tract diseases and the promotion of quality of life and financial protection of persons
with ESRD.
Intensify and improve data collection on renal disease registry, compliance of medical practitioners
and knowledge, attitude and practices (KAP) of the public regarding renal diseases
Page | 86
5.2.2.3. Mental Health and Mental Disorders

WHO estimates that 800,000 people commit suicide every year, 86 percent belonging in low- and middle-
income countries. In the Philippines, there is an increasing trend of mortality rate from suicide and self-
inflicted injuries which has reached a level of 2.2 deaths per 100,000 population in 2005 (Department of
Health, 2005) (see Figure 45). Mental and behavioral disorders were identified to be part of the 17 Cause
Groups of Mortality showing 1,061 affected individuals (males - 824; females - 237) with total deaths of
around 0.2 percent of the population affected (Department of Health, 2005). A more recent report from WHO
showed alarming percentages on mortality from neuropsychiatric disorders affecting more females than
males.

FIGURE 45. TRENDS IN MORTALITY RATE FROM SUICIDE AND SELF-INFLICTED


INJURIES, PHILIPPINES, 1980-2005

2.5

2
Mortality Rate per 100,000 population

1.5

0.5

0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year

Source: Philippine Health Statistics, DOH, 2005

There is no existing system for reporting mental health cases in the country and epidemiological studies are
fragmented and there is lack of updated data when it comes to mental health. In the year 2000, NSO reported
that mental illness is the third most common form of disability after visual and hearing impairments (National
Statistics Office, 2000). It was documented from the same survey that the prevalence rate of mental illness in
the Philippines was at 88 cases per 100,000 population (National Statistics Office, 2000).

In 2004, data revealed that 0.7 percent of total households have a family member with mental disability
(DOH-SWS, 2004), while a 2006 study conducted by the DOH that was limited to government
employees revealed that 32 percent of respondents (n=327) have experienced a mental health problem in
their lifetime (Department of Health, 2006). Among the most prevalent diagnoses were specific phobias (15
percent), alcohol abuse (10 percent), and depression (6 percent). Males were most likely to have substance-
related problems than females. The DOH study concluded that mental health problems were significantly

Page | 87
associated with the following factors: ages 20-29 years, big families, and low educational attainment. Data
from the 2006 study showed that the overall prevalence of mental health problems in National Capital Region
was 32 percent, with a co-morbidity rate of 12 percent for other mental disorders (Department of Health,
2006).

Among patients diagnosed and treated, schizophrenia was the most frequent diagnosis, followed by mood
disorders. On the other hand, outpatient facilities received more patients with diagnoses of substance abuse
and neurotic disorders.

The economic burden of mental health is seen in the costs handled by the household. As mental illness
becomes chronic, more losses in terms of economic opportunities are experienced. Government expenditure
directed to mental health is 5 percent, majority (95 percent) of which goes to operations, mental hospital
maintenance and personnel salary (Department of Health, 1980-2010). The Philippine Health Insurance
Corporation recently covered mental disorders but restricted this only to patients with severe mental
disorders confined over a short duration. At this time, there are no data to say that mental disorders are also
covered by health maintenance organizations.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Mental health is promoted in the general population, the risks and
prevalence of mental disorders are reduced, and the quality of life of those who are suffering
from such conditions is improved.

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
Prevalence of mental
disorders per 100,000 NSO-PSY 88 (2000) < 88
Prevalence of population
mental illness is % Households with
reduced family member having SWS and DOH
0.7 (2004) < 0.7
any form of mental Study
disorder
Mortality from Mortality rate from
5.58 (2005)
suicide and suicide and intentional
DOH-PHS 2.5
intentional self- self-harm per 100,000
harm is reduced population

STRATEGIES FOR 2011-2016


Intensify health promotion and advocacy to include the conduct nationwide awareness on mental
health, mental disorder (e.g. depression and suicide) prevention and control through schools,
community and government offices
Build capacity of health workers in community diagnosis on mental health (knowledge, attitude and
practices) and its risk factors, early identification, management of new cases/relapse cases and proper
referral system.
Expand the provision of mental health services through public-private partnership

Page | 88
Develop policy and legislation for the enhancement of mental health program
Encourage research culture and capacity development on mental health
Establish database and information system and improvement of the Monitoring and evaluation
system for mental health
Develop model programs for mental health
Develop/ upgrade health facilities for mental health

5.2.2.4. Substance Abuse

The abuse of tobacco and alcohol is included among the predisposing factors for the development of non-
communicable or lifestyle related diseases. The abuse of addictive substances such as shabu
(Methampetamine hydrochloride) is also directly linked towards the development of mental illness and
disorders. Alcohol and drug abuse are often linked in the perpetration of petty and heinous crimes among
individuals and the disruption of peace and order in the communities in general.

5.2.2.4.1. Alcoholism

Filipinos consume approximately 4 liters of pure alcohol per head. The trend of the recorded adult per
capita consumption (age 15 and above) in the Philippines generally continued to increase from 1961
(0.75 liters of pure alcohol) to 2004 (3.75 liters of pure alcohol). The latest figures, however, masks
higher figures in 1996 (6.77 liters) and in 2003 (4.8 liters) (World Drink Report in WHO Global Status
Report on Alcohol, 2004).

The 2010 Midline Survey for the National Objectives of Health showed that one-third of all household
members are alcohol beverage drinkers. The highest prevalence of alcohol intake was seen among adults
(42.8 percent), followed by adolescents (31.3 percent), the elderly (27.2 percent) and children (14.1
percent) (Department of Health, 2009) (see Table 27).

Compared to the 2000 data, the prevalence of alcohol intake among adolescents remained the same;
decreased slightly for adults and increased slightly for the elderly. However, children that are alcohol
drinkers have increased significantly.

TABLE 27. PREVALENCE OF ALCOHOL BEVERAGE DRINKERS IN PERCENT, PHILIPPINES, 2000 AND 2010

Age Group 2000 2010


Adolescents 30 31.3
Adults 46 42.8
Elderly 22 27.2
Children - 14.1
Source: BOS-NOH, 2000, and NOH 2005-2010 Midline Survey, DOH, 2008

Page | 89
Many Filipinos who suffer from alcohol dependence and abuse do not consider it as a medical problem;
hence, they refuse to seek treatment even if their condition is chronic. Alcohol rehabilitation centers have
lower admission rates in contrast to institutions treating drug dependency. It is for this reason that most
cases go undocumented, and trends are not established. Despite the lack of data and statistics, the burden
brought about by alcoholism in homes and communities is apparent and has been a growing concern of
this country.

The primary goal for the following years is to reduce the harmful use of alcohol and its health-related
effects. This is a realistic goal that takes into consideration that social drinking is entrenched in our
culture and cannot simply be eliminated. The goal is to address the root causes of the problem: increased
consumption beyond moderate levels and particular patterns that beget the adverse effects of alcohol use.

5.2.2.4.2. Tobacco smoking

The Philippines is the top smoking country in the South East Asia and is one of the countries with the
cheapest cigarettes in the world. On average, a Filipino smoker consumes 1,073 sticks annually (World
Cigarettes 1: The 2007 Report). Each year, 87,600 Filipinos die from smoking-related diseases. The
Tobacco and Poverty Study in the Philippines shows that about 6 to 8 percent of mortality is attributed
to smoking-related diseases such as lung cancer, cerebro-vascular diseases, coronary artery diseases, and
chronic obstructive pulmonary diseases (Baquilod, 2006). Annual productivity losses from premature
deaths for the four smoking-related diseases are estimated at US $65.4 million to US $2.93 billion. The
total cost of illness for the four smoking-related diseases is estimated at US $2.86 billion to US $6.05
billion (Baquilod, 2006).

The same study shows that, among the poor, tobacco receives the second highest allocation after food, a
considerable 2.5 percent of total income. This is higher than the groups budget for clothing (2.3
percent), education (1.4 percent), and health (0.9 percent) (Baquilod, 2006). In the poorest households,
tobacco expenditure is almost 16 times higher than the per capita monthly expense on health, eleven
times higher than education, seven times higher than clothing, and twice higher than housing. Since
1995, the prevalence of tobacco use has been consistent at about 30 percent (National Statistics Office
and Department of Health, 2009). To prevent this and decrease the overall ill effects of tobacco, the
Philippine government has implemented policies on tobacco control.

The current focus of public attention on smoking is a public demand to push for amendments in tobacco
legislation. One such amendment is the posting of graphic health warnings on cigarette packs. This
increases overall public awareness of the ill effects of tobacco. Another is imposing a unitary tax measure
to support the price increase of tobacco and discourage consumption. The program, with the help of

Page | 90
other offices in the DOH, also seeks to implement other amendments to RA 9211 and local tobacco-free
and smoke-free ordinances in the provincial, municipal, and barangay levels.

5.2.2.4.3. Drug Abuse

The prevalence of drug abuse has increased from only 20,000 users in 1972 to about 3.4 million users in
1999 (1.8M regular users and 1.6M occasional users) (DDB Survey, 1999). This represents an increase of
about 100 percent per annum. In 2001, the Social Weather Station Survey estimated that between 2.2
million and 9.3 million Filipinos are drug users (Social Weather Stations, 2001). In 2005, a survey by the
Dangerous Drugs Board (DDB) showed an estimated 6.7 million drug users (Dangerous Drugs Board,
2005). The distribution of cases according to the types of illegal substances is summarized in Table 28.
The problem of drug abuse continues to plague not only urban areas but also rural areas. The National
Capital Region (NCR) remains as the area most affected by drug abuse, with 3,554 or 49.96 percent of
the total admissions nationwide (Department of Health, 1980-2010). Region III and Region IV follow
with 21.13 percent and 17.22 percent, respectively (Department of Health, 1980-2010).

TABLE 28. DISTRIBUTION OF REPORTED CASES OF DRUGS/SUBSTANCE ABUSE BY SEX AND TYPE
OF DRUGS/SUBSTANCE OF ABUSE, PHILIPPINES, 2008 AND 2009

Drugs/Substance 2008 2009


of Abuse Male Female Total Male Female Total
Shabu
(Methampetamine 2,193 215 2,408 1,755 137 1,892
Hydrochloride)

Marijuana 1,593 107 1,700 1,282 95 1,377


(Cannabis sativa)

Cough/Colds
43 - 43 22 3 25
preparation
Injectable 152 19 171 133 22 155
Inhalants 299 16 315 277 14 291
Source: Dangerous Drugs Board 2009, Philippine Statistical Yearbook, NSCB, 2010

Hand in hand with this increase in prevalence is a steady decline in admissions for treatment. The
reported cases of new admission for drug/substance abuse in DTR centers by the Dangerous Drugs
Board have been decreasing from 7,113 in 2003 to 2,013 in 2009 (Department of Health, 1980-2010)..
The decreasing trend is also observed among cases of re-admission in the DTR centers at 1,076 cases in
2003 to 488 cases in 2009 (Department of Health, 1980-2010).

Based on the 4,278 cases admitted in different treatment and rehabilitation centers, both residential and
out-patient facilities, male patients outnumbered female patients (9 males : 1 female), with a mean age of

Page | 91
28 years old. They are usually single (56.94 percent), unemployed (32.82 percent), have attained high
school education (30.62 percent), and come from families with an average monthly family income of PhP
14,980.59. Among the substances the patients have used, the top three most common in 2008 were
methamphetamine chloride (shabu), cannabis (marijuana), and contact cement (Department of Health,
1980-2010).

The battle cry of the DOH program campaign is Drug Abuse is Preventable, Drug Addiction is
Treatable. The program focuses on the establishment of services for drug treatment and intervention.
The majority of the facilities for drug treatment and intervention concentrate on the residential/ in-
patient rehabilitation of people dealing with substance abuse. The program aims to ensure one
residential/in- patient rehabilitation center per region, one confirmatory drug-testing center per region,
and one physician per municipality. The DOH continues to seek more proactive ways in addressing other
substance-abuse problems, such as alcohol and nicotine.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Prevalence of tobacco smoking, alcoholism and substance abuse and
their health-related effects are further reduced.
Strategic Data
Indicator Latest Baseline 2016 Targets
Objective Source

Prevalence of % Prevalence rate of dangerous drugs DDB-


substance abuse is abuse among adolescents, adults, and DILG
reduced older persons Study
1. Student: 10.9 9.36*
2. Out-of-School Youth: 9.97 8.56*
3. Adult employed: 48.4 25.72**
4. Unemployed: 30.76 16.35**
(2008)
% Prevalence rate of current tobacco
smoker
GATS
1. Adult population: 28.3 (2009) 24*
and
2. Adolescents aged 13-15 years: 21.7 (2007) 12**
GYTS
3. Adult male: 47.7 (2009) 40*
4. Adult female: 9 (2009) 7.9*
% Prevalence rate of current alcohol 2010 data:
intake
NOH
1. Children 6-11 years: 14.1 8
Midline
2. Adolescents: 31.3 25
Survey
3. Adult: 42.8 36
4. Elderly: 27.2 21
To improve % Drug Treatment and Rehabilitation TRC TBD
completion rate of 100%
(DTR) completion rate Reports
treatment and
rehabilitations Number of readmission to DTR
DDB 488 (2009) 360
centers nationwide. centers
* Computed at 2.5 percent reduction annually
** Computed at 10 percent reduction annually

Page | 92
STRATEGIES FOR 2011-2016
Develop a more responsive promotion, education and advocacy campaigns
Promote and advocate for the full implementation of WHO-FCTC
Enhance the enforcement of standards for human resources and facilities involved in providing
services on addiction regulation by the Department
Review and redirect policies on the implementation of intervention and treatment programs based on
health-focused models
Develop service packages that might be included as part of the NHIP
Supervise and implement the rehabilitation and aftercare programs in all regions in the country
Capacitate human resource in the conduct of interventions and treatment programs for drug
dependents
Continuously maintain and manage the information systems developed by the Department
(Integrated Drug Testing Operations and Management of Information System or IDTOMIS) to
provide updated information for policy development and program implementation
Regularly monitor and evaluate program implementation

5.2.2.5. Accidents and Injuries

Accidents and injuries consistently remain as one of the leading causes of morbidity and mortality in the
country. The mortality rate from accidents gradually increased (see Figure 46) from 18.7 deaths per 100,000
population in 1980 to 23 per 100,000 in 1996 (Department of Health, Various years). An abrupt increase was
observed, reaching a level of 39.2 deaths per 100,000 population in 2005, almost double the mortality rate
observed in 1996 (Department of Health, Various years).

FIGURE 46. TRENDS IN MORTALITY FROM ACCIDENTS AND INJURIES, PHILIPPINES, 1980-2005

45

40

35
Mortality Rate per 100,000 population

30

25

20

15

10

0
1980
1981
1982
1983
1984
1985
`1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

Year

Source: Philippine Health Statistics, DOH, 1980-2005

In the Philippines, 38 percent of all causes of deaths from accidents and injuries are due to assaults, followed
by deaths from transport accidents at 20 percent as shown in Table 29 (Department of Health, 2005). Other
deaths from accidents and injuries are secondary to drowning, suicide, accidental falls, forces of nature, legal
interventions, fire, and other undetermined causes (Department of Health, 2005).
Page | 93
TABLE 29. CAUSES OF ACCIDENTS AND INJURIES, PHILIPPINES, 2005

Kinds of Accidents and Total Number of Percentage from


Injuries Deaths Total Accidents
Assaults 12,705 38.12
Transport accidents 6,770 20.31
Events of undetermined intent 4,029 12.09
Drowning and submersion 2,635 7.91
Intentional self-harm 1,861 5.58
Accidental falls 1,582 4.75
Others 3,745 11.24
Total 33,327 100.00
Source: Philippine Health Statistics, DOH, 2005

Despite the abrupt increase in the incidence of accidents and injuries from traffic accidents in recent years,
the trend in case fatality rate is noted to be going down. This may be attributed to several factors like the
enactment of Republic Act 8750 in 1999 requiring the mandatory use of seat belts among motorists and the
improvement of capability of health facilities to respond to such cases.

The DOH shall continue to advocate for the necessary policy instruments (i.e., laws; executive orders; and
ordinances to congress, other agencies, and LGUs). The Department shall also promote the execution of
multi-disciplinary and multi-sectoral solutions and researches for purposes of developing national and local
competence on injury prevention, health care services, and for other purposes that may be necessary. These
approaches shall ensure sectoral and community-based interventions to propel actions on violence and injury
prevention.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Morbidity and mortality from accidents and injuries are reduced.
Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
Mortality rate from
39.1
accidents and injuries DOH-PHS 34
Mortality rate due to (2005)
per 100,000 population
accidents and
Morality rate from
injuries is reduced.
transport accident per DOH-PHS 21.31 (2005) 17.5
100,000

STRATEGIES FOR 2011-2016


Integrate all sources of data on violence and injuries from different departments to form a central
database to serve as a basis for the development of appropriate prevention strategies and
interventions
Implement on a nationwide scale the National Electronic Injury Surveillance System to establish a
common or standard set of injury related data that can be used for developing necessary guidelines
towards minimizing violence and injuries

Page | 94
Form inter-sectoral management committees that can closely coordinate and collaborate to
harmonize efforts in violence and injury prevention
Establish and expand initiatives to address violence and injuries through education, enforcement of
existing policies, engineering, and economic incentives.

5.2.2.6. Blindness

Blindness comes in varying degrees. Legally blind pertains to people who, because of the severity of their
error of refraction (near- or far-sightedness), are not able to function without the aid of prescription
eyeglasses. Individuals who are totally blind, on the other hand, have lost the ability to completely see.
Blindness may affect only one eye (monocular) or both eyes (bilateral). Causes of this disability include
cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy, trachoma, and eye conditions in
children.

Globally, in 2004, about 314 million are visually impaired with 45 million considered to be blind. The leading
causes of blindness worldwide are cataracts (39 percent), uncorrected refractive errors (18 percent), glaucoma
(10 percent), age related macular degeneration (7 percent), with the rest accounted by corneal scars, diabetic
retinopathy, trachoma and childhood blindness, onchocerciasis and others. Of the 45 million who are blind
worldwide, up to 85 percent are avoidable by prevention, treatment or cure (Department of Health, 1980-
2010).

Challenges, such as the lack of priority given to eye health, the lack of equipment and resources, inadequate
public health facilities providing eye care services, and differences in approach among partner institutions,
hinder the progress of the program. With increased PhilHealth coverage focused on population sectors
needing better access, improved networking and collaboration efforts, and a more integrated health care
system, these difficulties will hopefully be addressed. Blindness is an urgent public health problem and effects
extend beyond the affected individual. The blind person and the caregiver, usually a family member,
experience lost earnings, resulting to a twofold loss in economic productivity. Added to this are costs of
treatment, special equipment, visual aids, and even premature death resulting from visual impairment (World
Health Organization).

In addition to cataracts, error of refraction and childhood blindness were also found to be the leading causes
of preventable blindness. Ageing, smoking, ultraviolet radiation, and diabetes are main risk factors for these
conditions. Infants also have a greater chance of acquiring eye defects if they are born prematurely
(retinopathy secondary to prematurity) or if their mothers suffered from diabetes during pregnancy (inborn
cataract).

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The Prevention of Blindness Program of the DOH aims to address these issues through collaboration and
partnership with all stakeholders and the adoption of the WHOs Vision 2020 to increase cataract surgical
rate, reduce visual impairment due to refractive errors and reduce the prevalence of visual disability in
children. The program was established in November 2004 under Administrative Order 179. By identifying
and managing eye conditions in the primary level of health care, blindness and its adverse results can be
prevented. This program will decrease the morbidity of blindness, and keep the incidences and backlog of
blind cases to a minimum.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: To reduce the prevalence of avoidable blindness in the Philippines
through the provision of quality eye care

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
Prevalence of % Prevalence of
visual disability in visual impairment
the general (national, all Special Survey 2.58 <2.58
population is causes)
reduced
Prevalence of
% Prevalence of visual
visual 0.43 0.20
disability in children < Special Survey
disability in (2002)
20 years old
children is reduced
Avoidable visual
% Visual <0.46
impairment due to 0.46
impairment due to Special Survey
cataract is reduced
cataract
Avoidable
blindness % Visual
due to error of impairment due to
Special Survey 43.4 (estimate) 28
refraction is uncorrected
reduced. refractive errors

STRATEGIES FOR 2011-2016

Detect potential blindness and cases early through the Community Health Teams and provide
information on the prevention of blindness by authorized information provider.
Treat and manage cases promptly
Integrate care in the service delivery network to include the private and public sector, local and national
organizations.
Monitor and evaluate to include reporting of cases from the public and private sector.
Advocate blindness prevention program. The local public health authorities taking responsibility for
sustaining and improving interventions for the reduction of blindness using the public-private
partnership (PPP) approach

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5.3. HEALTH RISKS AND DISASTERS
5.3.1. OCCUPATIONAL HEALTH RISKS
There are approximately 35.5 million workers distributed among the major occupation groups (Department
of Labor and Employment, 2009). Of these, less than 10 percent receive occupational safety and health
protection and services (Department of Labor and Employment, 2009). With increasing economic activity,
the trends of occupational diseases, injuries and accidents will likewise increase, yet very few will have access
to appropriate health care for their occupation-related injuries or illnesses. Moreover, the victims of such
incidents are likely the individuals who are the primary sources of income for their families. The additional
cost and loss of working days becomes an added burden to individuals and the country as a whole.

According to a survey of non-agriculture-related occupational injuries, a total of 44,800 incidents occurred in


4,600 establishments that employed 20 or more workers. Two-thirds of these are in the manufacturing sector,
followed by the wholesale and retail trade (8.1 percent), hotel and restaurants (7.4 percent), and financial
intermediation (0.3 percent). Of the injury cases, 60 percent required first-aid treatment and thus did not
entail days away from work (Department Of Labor and Employment, 2010). Majority were temporarily
incapacitated. Fortunately, this type of injury does not keep the worker from returning to his normal duties.

Workplace-acquired musculoskeletal diseases were the most prevalent, accounting for 28.2 percent of the
total occupational diseases. Other types of diseases that accounted for more than 10 percent of total reported
occupational diseases include bronchial asthma (18.5 percent), infections (13.8 percent), essential
hypertension (13.0 percent) and occupational dermatitis (12.6 percent) (Department of Health, 1980-2010).

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Reduce the health burden from occupational diseases, injuries and
accidents

Data
Strategic Objective Indicator Latest Baseline 2016 Targets
Source
% Workers who become
Morbidity, disability
disabled as a result of Special
and mortality from
occupational hazards surveys
adverse occupational To be determined To be determined
% Workers died due to and
conditions are
occupational reports
reduced
hazards
An occupational % Cities and municipalities DOH
health information with occupational health and TBD 40 percent
system is established information systems DOLE
% Health facilities providing
DOH - 8.51
Occupational health special clinical assessment and 40
BSNOH (2000)
programs at the local treatment services to workers
level established % Health centers with stress DOH - 19.15
40
management services BSNOH (2000)

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STRATEGIES FOR 2011-2016

Protect individuals, families, workers and communities from exposure to occupational and
environmental hazards, disease agents or stressors that could affect their health, through public
health and environmental interventions.
Set up healthy and safe workplaces in national agencies and LGUs. Key local health workers
(provincial health officers, city health officers, municipal health officers, rural health physicians and
public health nurses) will be trained on the prevention, recognition and management of occupational
health-related diseases in coordination with the DOH.
Strengthen infrastructure, human resource capabilities and systems for the registration of
occupational diseases and injuries.
Generate baseline health assessment information on workers in high-risk industries or hazardous
workplaces.
Review, update and strengthen laws, standards and regulations related to occupational health to make
them relevant and practical for more decisive enforcement by LGUs and the labor sector.
Conduct health promotion activities for the workers in industrial establishments.
Develop policies on integrating basic occupational health services into the National Health Insurance
Program. This is to target the workers in the informal sector in high risk industries(e.g. transport,
mining and agriculture)
Upgrade the capacity of personnel in the Department of Health and Local Government Units in
responding to occupational health and its related concerns
Establish coordinative linkages and meetings with partners that target DOH and other government
agencies, academe, industry, Philippines National Poison Management and Control Center, non-
governmental organizations and professional organizations.

5.3.2. DISASTERS AND EMERGENCIES

The country is located along the typhoon belt in the Pacific and within the circumferential Pacific Ring of
Fire, which explains why the Philippines experiences about an average of 22 typhoons per year and constant
threats from eruptions of its 300 volcanoes, 22 of which are currently active. Since 2005, the number of
natural disasters has been steadily increasing, while manmade emergencies have fortunately been on the
decline since 2007. Typhoons Reming (2006), Frank (2008), Ondoy (2009), and Pepeng (2009) caused a lot of
damages in the country, destroying public and private properties indiscriminately. Although most typhoons
pass through Region II, their worst hits are felt in Regions I, III, IV-A, CAR, and Metro Manila. Deaths due
to disasters have been increasing since 2007 and injuries have reached to 19,101 cases for 2008 (Department
of Health, 1980-2010).

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FIGURE 47. TYPES OF EMERGENCIES, PHILIPPINES, 2009

Figure 47 shows the type of emergencies in


the Philippines. Natural emergencies like
5% tropical cyclones, flooding/ flashfloods,
16%
landslides, volcanic activity, and earthquakes
47% constitute 27 percent of the emergencies in
the Philippines. Technological emergencies
like poisoning, transportation accidents, and
27% fire constituted most (47 percent) of the
disasters in 2009. Three of the major
5%
emergencies in transportation are the sinking
of the MV Blue (2006), the MV Princess of
the Stars (2008), and the Super Ferry 9 (2009).
Deaths due to disasters have been increasing
Technological Biological Natural Societal Others
since 2007 and injuries have reached to 9,101
Source: Philippine Health Statistics, DOH, 1980-2005 cases for 2008 (Department of Health, 1980-
2010) (see Figure 48).

FIGURE 48. NUMBER OF DEATHS AND INJURED PERSONS DUE TO EMERGENCIES,


PHILIPPINES, 2007-2009

10000
9000
8000
7000
6000
Number of persons

5000
4000
3000
2000
1000
0
2007 2008 2009

Year
Deaths Injured

Source: Department of Health, 2009

The Philippines aims to be the Western Pacific Regions model in Health Emergency Management. In order
to achieve this, the DOH makes use of the following 10 Ps as a strategic tool: Policies, Plans, Procedures/
Protocols and Guidelines, People, Promotion and Advocacy, Partnership Building, Physical Facilities
Enhancement, Program Development, Practices and Peso and Logistics.

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NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Reduced morbidity and mortality during emergencies and disasters

Strategic Indicator Data Source Latest Baseline 2016 Targets


Objective
Reduce the Number of deaths DOH report 7,212 < 7,212
number of deaths related to disasters
and injuries related DOH report 1,497 < 1,497
Number of injuries
to disasters
related to disaster

STRATEGIES FOR 2011-2016


Increase the capacity of the LGUs on disaster preparedness and response and management of health
emergencies
Identify coordinators at every province/city levels and LGU hospitals in order to facilitate the expansion
of network in all regions.
Expand the Hospital Emergency Preparedness Response and Rehabilitation Plans (HEPRRP) to other
local government units (LGUs) across other regions.
Strengthen the support systems for disaster preparedness and response.
Strengthen monitoring and evaluation of disasters situation.

5.3.3. CLIMATE CHANGE

In the Philippines, climate change has been measured as a 0.6104C increase in annual mean temperature.
From 1900 to 1950, the country had experienced a mere 0.3472C increase in the mean temperature. From
1950 to 2006, an increase of 0.8904C in the annual mean minimum and maximum temperatures was
reported, placing the Philippines in a state of climate change (Department of Science and Technology). These
deviations pose a great threat as they inevitably affect human health directly and indirectly. Direct impacts of
climate change include the effects of changes in exposure to extreme weather, increased incidence of
extreme weather events, and increased production of certain air pollutants and aeroallergens. These are
measurable, but are infrequent. Indirect impacts, on the other hand, include changes in complex processes,
such as the transmission of water, food, and vector-borne infectious diseases, and effect on regional food
productivity. Such effects are more prevalent, although harder to measure (World Health Organization, 2003).
This non-linear relationship between climate and health has made understanding and resolving the possible
health impacts of climate change more complex.

In the epidemiologic triad of environment-host-agent, the environmental dimension in disease causation has
acquired larger significance as the environment affects the life cycle of disease agents and the climate
sensitivity of humans to diseases (Department of Health, 1980-2010).

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The importance of this change was seen in correlations established between certain climate variables and the
prevalence of vector-borne diseases, namely dengue and malaria. A comparison of the number of malaria
cases and the temperature increases from 1995 to 2005 shows that trends in the malaria cases mirror those of
the changes in temperature. The peak temperature increase during the 1998 El Nio Phenomenon
corresponds to a sudden increase in the prevalence of malaria in the country. This pattern also holds true for
the number of dengue cases from 1992 to 2005. The effects of climate change on water-borne diseases such
as cholera, diarrhea, and typhoid fever and on conditions like under-nutrition, upper respiratory tract
infection, cataract, skin cancer, and mental health are also considered, together with direct impacts such as
deaths and illnesses due to flooding, heat wave, and other calamities. These conditions are studied particularly
in populations such as the children and the elderly, chronically ill and disabled individuals, and low income,
homeless, and subsistence groups, who are more vulnerable to the negative effects (Department of Health,
1980-2010).

Since the climate change and health initiative is only in its infancy, gaps remain that must be addressed. These
include the implementation of a sectoral climate change adaptation framework, the need to create integrated
systems and mechanisms, particularly national and local coordination mechanisms and private-public
partnerships, and the issue of resilience and readiness of health facilities to respond to the effects of climate
change (Department of Health, 1980-2010). Other issues include technical gaps such as: (1) the need for a
national health assessment to look at the vulnerabilities both at the national and local level, while considering
risk factors, e.g., geography, socio- economics, and others; (2) creation of means of assessment of the burden
of climate-sensitive health outcomes, which enable the measurement and identification of response
mechanisms; (3) the necessity of continuous, more in- depth research and development in the climate
change and health relationship; and (4) correlation studies on zoonotic diseases, and on the connection
between biodiversity and climate change and health impacts (Department of Health, 1980-2010).

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NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: To build the capacity and strengthen health systems of national and
local government units for the impact of climate change on health.

Data Latest 2016


Strategic Objective Indicator
Source Baseline Targets
Number of LGUs with
Capacity of key government and trained personnel on the
5 cities(NCR)
agencies and local government units prevention and LGU Annual 30 provinces/
5municipalities
for managing the health impact of management of the Reports cities per year
(Albay)
climate change is strengthened. health impact of climate
change
Number of health DOH
Climate change adaptation concerns To be All health
programs with climate Annual
mainstreamed in all health programs determined programs
change element Report
Individuals, families and
communities understanding on the Rate of improvement of Special To be
Priority LGUs
impact of climate change is knowledge Survey determined
improved
Individuals, families and
communities health seeking
Rate of improvement in Special To be
behavior to prevent the occurrence of Priority LGUs
health seeking behavior Survey determined
illness brought by climate change is
improved

STRATEGIES FOR 2011-2016


Develop policy and systems including the programs or systems integration for climate change
Conduct epidemiological research to determine the nature and to measure the impact of different
aspects of climate change on health outcomes (to help in future priority-setting)
Develop PhilHealth benefit packages for climate change related diseases and morbidities
Develop new health-related technologies, tools and guidelines to support multi-sectoral efforts
Strengthen information campaign, advocacy, policy development, capacity building and health
systems support as part of multi-sectoral efforts to manage impact of climate change
Monitor and evaluate interventions to manage the health impacts of climate change
Build partnership both in the national and local levels, with implementation spearheaded by the
Department of Health

5.4. HEALTH OF POPULATION GROUPS


The challenge remains in providing care and nurturing of vulnerability and risk among population groups
such as the adolescent and youth, adult men and women and older persons. The approach to protect and
promote the health of the vulnerable groups varies as one goes through the different stages of life. Health
service packages specific for each stage differ and this should be made available to ensure a positive state of

Page | 102
well-being of the individual. They require more focused preventive efforts as a group. Understanding their
needs and differences will aid in the development of intervention that is more focused and tailor fitted to the
group. The goal is to decrease the health inequalities between socially defined groups and ensure access to
quality health care for adolescents, adult males and females and older persons. The care for children and
mothers is already presented under MDG 4 and 5.

5.4.1. ADOLESCENT AND YOUTH

By definition, adolescence is defined by the WHO as the period of life between 10 and 20 years old while the
youth refers to those between 15 and 24 years old and the young people refers to both age groups, meaning
those aged 10 to 24 years.

The adolescent age group in the country numbers around 19,404,800 and makes up 21 percent of the total
population (National Statistics and Coordination Board, 2010). They are considered the healthiest age group. However,
special characteristics possessed by adolescents make them vulnerable to certain health problems. First, their
adventurous and bold behavior is attributed in the increased occurrence of accidents and injuries leading to
death. In 2005, accidents ranked as the most common cause of death among young adolescents, leading to
1,130 premature deaths (Department of Health, 2005). Second, their sexual curiosity, combined with poor sexual
and reproductive health education and services, poses serious problems, such as STI/HIV/AIDS. Between
2006 and June 2010, the number of newly tested HIV positive youth (15 to 24 years old) went from 39 to 222
cases, an 815 percent increase, while fifteen- to nineteen-year-old adolescents who tested positive for HIV
increased from five in 2006 to 35 in 2010 (up to June) (Department of Health, 2010). This represents an increase of
700 percent.

Unwanted teenage pregnancies are other devastating events for adolescents. It causes significant
psychological distress and is considered as a high-risk pregnancy. As of 2008, 10 percent of adolescent girls
aged 15 to 19 years old have begun bearing children, increasing from 8 percent in 2003 (National Statistics Office,
2008). Third, the attitudes and behavior of adolescents towards health are likely to get carried over to
adulthood. Substance abuse, (often involving alcohol, recreational drugs, and smoking) often begin when they
are young. Reports regarding these negative behaviors among Filipino adolescents indicate that 17 percent
have been drunk at least once, 4.5 percent have used recreational drugs, and 9.7 percent have smoked (World
Health Organization, 2007).

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NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: The total health and well-being of young people are promoted.

Latest
Strategic Objective Indicator Data Source 2016 Targets
Baseline
Mortality rate per 83.02
DOH-PHS 70
100,000 youths (2010)
Mortality among
Mortality rate per
youths (10-24years
100,000 among 10-24 41.97
old) is reduced DOH-PHS 35
years old due to (2010)
accidents and injuries

Reproductive health
% Pregnancy rate
among adolescents is NSO-NDHS 9.9 (2008) 4
among adolescents
improved
Malnutrition among
% Adolescents that
adolescents aged 11-19 FNRI-NNS 4.6 (2008) 3
are obese
years old is reduced

STRATEGIES FOR 2011-2016


Ensure safe and nurturing environment for adolescents by protecting their rights.
Develop the adolescent health service package and involve the youth in the development and
provision of services.
Address and provide reproductive health needs of the adolescents through the provision of
information and education and quality health services.
Scale-up capacity-building of adolescent-friendly health services at the regional, provincial and local
levels.
Expand capability-building to include community health workers and youth volunteers (e.g.
orientation program on Adolescent and Youth Health and utilization of Adolescent Job Aid).
Provide the necessary logistics and commodities for use in the Adolescent Health Program.
Engage the adolescent in creative and productive activities and involve in the country and
community development programs.
Expand health care financing package for other essential services on adolescent health.
Local stewardship for improving health outcomes for the adolescent and youth. The local public
health authorities taking responsibility for sustaining and improving interventions for the adolescents
using the public-private partnership (PPP) approach

5.4.2. THE ADULT MEN

In the Philippines, adult men ages 25-59 have poor health status. They display the highest level of health risk
behavior and the lowest use of health services compared to other groups. The number of Filipino males aged
25-59 years old is close to 16 million or about 19 percent of the total population and 38 percent of the total
male population (National Statistics and Coordination Board, 2010).

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The leading causes of death for the adult male population only slightly differ from those of the entire Filipino
population. But diseases that are more fatal to Filipino males than females are quite different. Table 30
shows that cardiovascular diseases followed by accident and injuries are the leading causes of death among
Filipino males.
TABLE 30. LEADING CAUSES OF DEATH AMONG FILIPINO MALES AGED 25-59, PHILIPPINES, 2005
% of males % of adult
Number
Rate per among total males aged 25-
Rank Causes of deaths of
100,000 deaths of adults 59 among total
deaths
aged 25-59 deaths
1. Cardiovascular diseases, all forms 28,370 169.84 19.94 6.66
2. Accidents and injuries, all forms 17,701 105.97 12.44 4.15
3. Malignant neoplasms, all forms 9,627 57.63 6.77 2.26
4. Tuberculosis, all forms 8,716 52.18 6.13 2.05
5. Diabetes mellitus 3,876 23.20 2.72 0.91
6. COPD 3,846 23.02 2.70 0.90
7. Chronic liver diseases and cirrhosis 3,803 22.77 2.67 0.89
8. Pneumonia 3,251 19.46 2.28 0.76
Nephritis, nephritic syndrome and
9. 3,136 18.77 2.20 0.74
nephrosis
10. Gastric, duodenal, peptic and
gastrojejunal ulcers and other 2,667 15.97 1.87 0.63
diseases of the digestive system
Source: Philippine Health Statistics, 2005

Eight (8) out of ten (10) causes of the total deaths among adult males aged 25-59 are due to non
communicable diseases where the cardiovascular diseases (19.94 percent) followed by accidents and injuries
(12.44 percent) are the highest (Department of Health, 2005). The communicable diseases among the leading
causes of deaths are tuberculosis and pneumonia.

There are diseases that are primarily of male concern like the occurrence of benign prostatic hyperplasia and
prostatic malignancies (see Table 31). These increase in incidence as the males grow older and can be
detected through regular digital rectal examination. On the other hand, deaths due to acute pancreatitis are
often associated with alcoholic binges among the male population.

TABLE 31. CAUSES OF MORTALITY THAT HAS MALE PREPONDERANCE AMONG FILIPINOS, 2000 and 2005

2000 2005
Causes of deaths Number Rate per 100,000 25- Number of Rate per 100,000 25-59
of deaths 59 male adults deaths male adults
Acute pancreatitis 1,405 9.67 1,945 0.01
Malignant
neoplasm of the 104 0.72 178 0.00
prostate
Hyperplasia of
9 0.06 22 0.00
prostate
Source: Philippine Health Statistics, 2005

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DOH data on seropositive cases of HIV point out that 85 percent of all who tested positive were males from
19 to 49 years old. There is yet inadequate sex-disaggregated national data on illegal drug use and alcoholism,
but these have been known to result in disease and socio-economic problems among the male population.
The higher prevalence of smoking among males than females correlates well with the fact that of every three
who die of lung cancer two are males. The common denominator seems to be that certain behavioral patterns
among men can be modified to prevent the occurrence, complications and fatal outcomes of the diseases
predominantly affecting them.

Some risk factors leading to diseases in men have been studied: smoking, diet preferences and nutrition,
reproductive health habits, risk-taking behavior and occupational activities. Although the information was
generated for the purpose of monitoring and controlling the occurrence of disease or other unhealthy
conditions, all these information may be brought together to focus intervention on men, specifically Filipino
adult males between 24-59 years of age. In addition, the Healthy Lifestyle initiative and tobacco control
movement have made a head start towards behavior modification.

5.4.3. THE ADULT WOMEN

Not all females will pass through the stage of pregnancy and motherhood either by choice or biological
reasons. The objectives for pregnant and lactating women are discussed under the MDG 5. There are other
health needs of the Filipino adult female population aged 25-59 years old that must be addressed: their
reproductive health, gender issues and diseases affecting this population group.

Cardiovascular diseases are the leading causes of death among adult Filipino women in 2005 with a rate of
176.51/100,000 followed by malignant neoplasms with a rate of 60.36/100,000 (Department of Health, 2005). The
leading causes of death among females are mostly degenerative and lifestyle-related in nature. TB and
pneumonia are the only infectious diseases included in the leading causes of mortality among Filipino females.
It can be observed that the only disease among the 10 leading causes of mortality that has higher percentage
among females than among males are goiter, thyrotoxicosis, hypothyroidism and endocrine and other
metabolic disorders wherein 55.62 percent of those who die of the said diseases are females (Department of
Health, 2005).

Table 32. Essential Health Care Package for Adult Male and Female

1. Management of illness
2. Counseling on substance abuse, sexuality and reproductive tract
infections
3. Nutrition and diet counseling
4. Mental health
5. Family planning and responsible sexual behavior
6. Dental Care
7. Screening and management of lifestyle related and other degenerative
diseases

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Malignant neoplasms are the second leading causes of death among adult Filipino females. These diseases
when caught at the early stage, can greatly improve the treatment outcome and survival of patients. Among
adult females aged 25-59 it is breast cancer which has a death rate of 20.57 per 100,000 populations, uterine
malignancies at 5.37 per 100,000 population and cervical cancer at 5.17 per 100,000 populations as shown in
Table 33(Department of Health, 2005).

TABLE 33. MALIGNANCIES WITH PREPONDERANCE AMONG FEMALES AGED 25-59, PHILIPPINES, 2005 and 2010

2000 2005
Malignancies Number Rate per 100,000 25-59 Number of Rate per 100,000 25-59
of deaths female adults deaths female adults
Malignant
neoplasm of the 1,979 13.64 3,401 20.57
breast
Malignant
neoplasm of the 593 4.09 889 5.37
uterus
Malignant
neoplasm of the 563 3.88 855 5.17
cervix uteri
Source: Philippine Health Statistics, 2005

There are more Filipino females than males who die of diabetes mellitus and thyroid problems.

However, in terms of deaths due to infectious diseases like TB and pneumonia, only 28.75 percent and 36.91
percent of those who die of the said diseases, respectively are females. It can also be noted that there are
lesser percentages of females who die due to accidents and injuries.

International conventions on the rights of women to quality reproductive health care have clearly
acknowledged the vital role of men in family planning. On another front, HIV/AIDS experts have declared
that for the HIV/AIDS program in the Philippines, men hold the key to reducing HIV transmission and the
power to change the course of the AIDS epidemic.

In the same way that the role of men has been acknowledged as vital in the pursuit of goals to improve the
health of women and the family, the challenge is to direct the health sector toward issues and problems that
cause disease and death among men at levels unusually higher than females or than previous trends. In a
health care environment that has been women- and child-oriented since its inception, and in a sector that is
now dominated by females, ways must be found to shift health planning and administration towards
regarding men as specific beneficiaries of the health care system and for men to participate more actively in
the health promotion and health care programs for the community, family and men themselves.

Current health care provided to adults is disproportionately medicine-oriented and clinic-based. The
identified causes of mortality and morbidity among adult men clearly show that majority are preventable, and

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the more appropriate, high-impact and long-term interventions could be the modification of the political,
socio-cultural and psychosocial environments. The Healthy Lifestyle program has not retrained its focus
towards adolescent and adult men even if past studies have shown them to have a higher propensity to
indulge in risky behaviors.

The essential components of the health care package for adult men and women are enumerated above. These
services must be provided to ensure optimum health and prevent mortality and morbidity among adult men
and women in the general population.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Promote the total health, well-being and quality of productive life of
adult men and women

Latest
Strategic Objective Indicator Data Source 2016 Targets
Baseline
Mortality rate per
DOH-PHS 1,000 (2005) 900
Mortality among adults 100,000 adult males
is reduced Mortality rate per
DOH-PHS 1,000 (2005) 900
100,000 adult females

STRATEGIES FOR 2011-2016


Improve the overall participation of men in the health care system. Men should be made to actively
participate in the development of health services appropriate to their needs and in setting up the
organizational system that will provide health care for them.
Develop male-focused information systems and strategic communication plans that will be used to
harness local and national government and non-government resources towards effectively addressing
the health care needs of men, aside from their participation in reproductive health programs.
Develop and implement a health package for the Filipino adults. Focus on gender-specific packages
responsive to the different health needs of adult men and women.
Improve the health-seeking behavior of the Filipino adults through health education and information
campaigns that are culturally-appropriate
Intensify the implementation of policies and laws that promote and protect health and improve the
quality of life of adult Filipinos.

5.4.4. THE OLDER PERSONS

Latest trend shows an increasing number of older persons and their longer life expectancy. The goal is to
improve the quality of life of older persons and sustain their function, autonomy, self-esteem and life
satisfaction. To undertake these goals to the DOH has developed a progressive older person health program.
Most of the leading causes of morbidity and mortality can be prevented and measures for health promotion
and disease prevention for this population group are available, thus reducing the countrys burden of diseases
is feasible.

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TABLE 34. LEADING CAUSES OF DEATH AMONG OLDER PERSONS, PHILIPPINES, 2005

% of older persons
Number of Rate per 100,000
Rank Causes of deaths among the total
deaths older persons
population
1. Cardiovascular diseases, all forms 79,065 1,704.21 18.56
2. Pneumonia 26,443 569.97 6.21
3. Malignant neoplasms, all forms 21,785 469.57 5.11
4. COPD 14,592 314.52 3.42
5. Tuberculosis, all forms 12,934 278.89 3.04
6. Diabetes mellitus 11,686 251.89 2.74
Gastric, duodenal, peptic and
7. gastrojejunal ulcers and other diseases of 6,040 130.19 1.42
the digestive system
Nephritis, nephrotic syndrome and
8. 5,062 109.11 1.19
nephrosis
9. Accidents and injuries, all forms 4,179 90.08 0.98
10. Chronic liver diseases and cirrhosis 2,483 53.52 0.58
Source: Philippine Health Statistics

In 2005, mortality data for older persons showed a preponderance of lifestyle related diseases as major causes
of mortality while Pneumonia and TB are the main causes of death that are infectious in nature as shown in
Table 34 above.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Quality of life among older persons is promoted and contributes to the
nation building.
Latest
Strategic Objective Indicator Data Source 2016 Targets
Baseline
Mean life expectancy
NSO-PSY 66.11 (2010) 68
Mean life expectancy is for adult males
increased Mean life expectancy
NSO-PSY 71.64 (2010) 73
for adult females

STRATEGIES FOR 2011-2016


Redefine the minimum health care package for older persons to include primary, secondary and tertiary care.
The package should consist of health services tied up with pre-financed sources of care in order to improve
accessibility by older persons.
Build the capacity of human health resources toward the promotive, preventive, curative and supportive care
for older persons.
Integrate into current licensing and accreditation requirements, building, facilities, equipment and personnel
standards appropriate for care of older persons.
Develop community-based and institution-based models of health care for older people.
Pursue the implementation of laws and policies for the protection and improvement of the quality of life of the
older persons such as the RA 9257 or The Expanded Senior Citizens Act of 2003.
Local stewardship for improving health outcomes for the older persons.
Local public health authorities taking responsibility for sustaining and further improving the older person
interventions using public-private partnership (PPP) approach with the public sector taking the lead.

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HEALTH SUPPORT SYSTEMS
6.1. LOCAL HEALTH SYSTEMS
The implementation of the Local Government Code of 1991 resulted in the devolution of health services to
local government units (LGUs) which included among others the provision, management and maintenance of
health services at different levels of LGUs. What used to be a centralized national health system became
many independent local health systems. After more than seventeen (17) years of devolution, improvements in
health status of populations show marked variations across LGUs. Variations in health status were associated
with variations in the performance of health care providers and health care professionals in localities.

In spite of the devolution, the DOH is still the institutional steward of the nations health system. As the
prime national health agency, it has the authority to provide coherence and direction in enhancing operational
effectiveness of local health systems towards improved health status in localities. The DOH encouraged
provinces and their component municipalities and cities to plan together and develop a five (5) year Province-
wide Investment Plan for Health (PIPH). This medium-term health plan became the key instrument that
DOH utilized to forge partnership with the LGUs towards improved health outcomes, more equitable
financing of health care and greater public satisfaction. As an approach to health reforms, the PIPH
represents all the stakeholders interests since all LGU officials and health stakeholders plan together to
improve the health system of the province.

As of 2010, 80 provinces and 8 cities have completed their five (5) year investment plans for health
(PIPH/CIPH) including their annual operational plans (AOP) (Department of Health, 1980-2010). These
Plans undergo a review by a Joint Appraisal Committee (JAC) prior to DOH approval. The signing of a
Memorandum of Agreement (MOA) between DOH and the LGU to support local health reform
implementation triggers a series of inter-related events to facilitate the annual operationalization of the
PIPH/CIPH: (1) release of start-up funds to jumpstart plan implementation ; (2) review and approval of the
AOP; (3) forging of an annual DOH-LGU Service Level Agreement (SLA) which details DOH and health
partner commitments as contained in the AOP ; (4) release of the DOH annual fixed allocation and other
support; and (5) release of a performance-based incentive for the previous year achievement of specific
indicators from the Local Government Unit (LGU) Scorecard.

The LGU Scorecard is the tool institutionalized by the DOH to track and assess the overall outcome of
implementing health reforms in the province-wide health system (PWHS). It measures intermediate
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outcomes of access, quality and efficiency including major reform outputs based on the Programs, Projects
and Activities (PPAs) of the DOH. The LGU Scorecard thus provides a composite performance assessment
of the efforts of various stakeholders within the PWHS.

Over time, a reformed PWHS will progressively achieve the national targets for the intermediate outcome
indicators and show all excellent rating (greens) in the LGU Scorecard. It will ultimately exhibit no
performance disparity across all its component municipalities/cities and inter-local health zones (ILHZs).
The goal for 2016 is to reduce the disparity of performance, particularly for the poor, among local health
systems (LHS). Local health development will be supported by building systems for evidence-based policies,
decision making and accountability mechanisms to strengthen local health authority, expand their partner and
support networks, and improve client-centered care and community participation adopting Primary Health
Care (PHC) principles in the context of Universal Health Care.

NATIONAL OBJECTIVES FOR 2011-2016


OVERALL GOAL: Reduce performance disparity among LGUs and vulnerable groups in
the country.

Data
Strategic Objective Indicator Latest Baseline 2016 Targets
Source
% Local health systems DOH
All PWHS and
with PIPH/CIPH Program
HUCs/ICCs is engaged
Report
in sectoral development
1. PWHS 100
prioritizing the poor, 100
2. HUC 24*
over a medium term 100
3. ICC 0
period 100
(2010)
% ILHZ that achieved DOH CHD
functionality in domain of reports
75% ILHZ
:public health protection, Baseline data for
Functional ILHZs that achieve 3
access to quality clinical ILHZs being
provide public health domains of
care and completed
protection, access to functionality
efficient management of
quality clinical care and
resources
efficient management of
% of GIDA DOH CHD/
resources are established
municipalities/ barangays Program
covered with a standard Reports or TBD 50
service delivery or Survey
financing alternative
DOH CHD
Local health capacity to % LGUs with excellent
/ Program 32
reduce disparity among (green) performance rating 80
Reports or (2009)
LGUs is strengthened in LGU scorecard
Survey
Service delivery systems % ILHZ with public DOH CHD
based on principles of private partnerships / Program
TBD 50
PHC, with public private Reports
partnerships, client % ILHZ with effective
centered care, and consumer participation
TBD 100
community participation systems
is improved
*computed at 8 out of 143 HUCs

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STRATEGIES FOR 2011-2016

Utilize the approved PIPH/CIPH and AOP to provide fund support and or technical assistance to
LGUs to ensure health reform implementation in localities.
Strengthen inter-LGU coordination in health operations through improved functionality of ILHZs.
Ensure access and availability of quality health care sensitive and responsive to the health needs of
communities in GIDAs.
Maximize PPP in health to improve access to quality health care, increase effectiveness and efficiency
in the delivery of services and enhance equity in the distribution of available resources.
Improve consumer participation and ensure greater client participation in improving the health care
delivery system through: (1) establishing a consumer-centered feedback mechanism; (2) increasing
the poors purchasing power; (3) providing health information (4) supporting consumers to co-
produce or co-finance health services; and (5) Involving consumers in the policy and decision-
making process, as well as in management.
Make optimal use of the following tools to track LGU performance: LGU scorecard, CHD
scorecard, Urban Health Equity Assessment & Response Tool and ILHZ functionality assessment
tool.

6.2. HEALTH INFORMATION SYSTEM

The problems of completeness, accuracy, timeliness and access to health data, and fragmentation of various
health information systems need to be addressed. Information systems that are managed separately by various
data producers bring about inaccessibility of quality data for decision making. Critical to harmonization,
interoperability and data exchange is an incessant multi-stakeholder collaboration among data producers and
users with shared agreements and unified efforts towards increasing availability, access and use of timely,
relevant and reliable health information. Use of available, relevant and cost effective information and
communication technologies (ICT) enhances the development of institutional networks and makes processes
and systems more efficient. It also enables health workers to do their work faster and better. The current
health sector enterprise architecture (EA) and the e-health strategic framework define the proper use and
function of ICT. Advancing in these areas will improve healthcare access, quality and efficiency of service
and higher level of client satisfaction and better safeguards for patient safety.

EA and e-health strategic framework have five priority focus areas in using ICT to support KP and these are
in various stages of development. These are defined as:

6.2.1. Enabling Structures and Resources

A rational and accountable eHealth agenda, with the essential legal and normative framework and
structures in place including standards, sustained financing, e-mature human resources, ICT
infrastructure and multi-agency collaborations.

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6.2.2. Critical Application Systems

Increased efficiency of processes and systems in health care delivery and administration through new
and better application systems and processes for Philhealth claims, health records, disease
surveillance, drugs management and price monitoring, financial and procurement management and
other regulatory support services.

6.2.3. Philippine Health Information System (PHIS)

The PHIN shall work towards harmonization and integration of data sources and information
systems using acceptable data management standards and protocols and support initiatives that will
enhance health service statistics reporting especially from LGUs and the private sector. This will also
include improvements and scale-up programs for Information Systems (ISs) in health centers,
hospitals and other critical information and service delivery centers and support service groups.

6.2.4. Knowledge Management

Greater and better capacity for exchange and utilization of knowledge resources and systems
especially at the sub-national levels based on KM4Health framework. The latter encompasses health
research, knowledge translation, including knowledge sharing and exchange programs such as call
centers, e-library, best practices, Communities of Practice (CoPs) or K networks among others.

6.2.5. Telemedicine/mhealth

ICT capacities are maximized in reaching GIDAs, attaining MDGs and in collecting data and
disseminating health information to policy makers, provider and citizens. Patient monitoring and
tracking programs for MDGs such as maternal and neonatal events and TB treatment compliance,
and disaster response shall be given priority focus.

In the execution of the strategic goals and targets, the following valued principles shall be applied: a) client-
focused approach b) collaboration and partnerships and user involvement c) good governance and
performance through judicious and efficient use of resources, transparency, accountability d) ethics in
safeguarding privacy and confidentiality e) shared learning f) simple and cost effective technology application.

Long-term progress in the execution of the target activities will also help achieve the global commitment of
the country in the 58th World Health Assembly and the 2011-2016 Philippine Digital Strategy vision - A
digitally empowered, innovative, globally competitive and prosperous society where everyone has reliable,
affordable and secure information access in the Philippines, a Government that practices accountability and

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excellence to provide responsive online citizen-centered services, and a thriving knowledge economy through
public-private partnership.

NATIONAL OBJECTIVES FOR 2011-2016

OVER-ALL GOAL:
Establish harmonized, quality, relevant and responsive e-health services to provide the
necessary tools, data, information and knowledge for evidence-based policy and program
development towards the provision of accessible, quality, affordable, efficient and safe
health services and attainment of better health outcomes for all Filipinos.

Strategic
Indicator Data Source Latest Baseline 2016 Targets
Objective
DOH Information
Health Sector e-Health Systems Strategic
DOH Report 1 Road map
The eHealth Road map established Plan (ISSP) 2011-
infrastructure is 2013
functional at Health sector enterprise Draft Health
various levels of architecture (EA) and Sector EA ,
ICT4H e-health
health care delivery segment architecture for formulated by IMS
Strategy Report , Feb 4 segment EAs
PhilHealth, central office, and the ICT4H e-
2012
CHD, hospital and health health Strategy
center developed Report , Feb 2012
Basic ICT infrastructure
DOH ISSP, 2011-
establish in central office, 50% 70%
2013
regional and local level
Health Information
Systems standards/ ICT4H e-health
Increase efficiency Health Information Strategy Report , Feb Only ICD 10 is
80%
of processes and technology Standards 2012, DOH and nationally adopted
systems in health (HISS/HITS) officially WHO Reports
care delivery and issued
administration The Philippine Health
Information Network PHIN, KM,
(PHIN), ICT4H and PNIDMS and
various data management DOH Report ICT4H at national 5 Regional PHINs
systems and communities levels only, KM
of practice broadened/ team at CHD6
expanded
Percent of health workers
who are ICT literate and DOH Report 10% 40%
adept on HISS/HITS
Percent of municipal and
city health offices with
functional health service
DOH Report 40% 70%
statistics reporting and
disease surveillance
systems with trained HRH
A health data
Improved data quality warehouse
DOH portal An uploading
with increased data access established and used
uhmis2.doh.gov.ph system and QMS
and utilization with regular
reports

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5 systems ( NCDs;
infectious disease;
disease surveillance ;
procurement,
Information and logistics and
application systems in financial
several priority areas DOH Report 1 management,
harmonized and document
implemented management;
hospital system with
Philhealth e-claims
modules and blood
supply
Data visualization system Dashboard with
DoH reports Phil. Health maps
established Health mapping
Knowledge Management
1 at national level,
hubs are expanded at DOH report 3 regional hubs
1 CHD
sub-national levels
% of hospitals with
PhilHealth Report 1% 100%
PhilHealth e-claims
% of hospitals with
functional management DOH- 45 DOH hospitals:
information system and DOH report LGUs 36 90%
compliant with HISS/ LGU hospitals: 30%
HITS
National Telehealth
DOH reports and Several pilot NTSP program
Services Program (NTSP)
contracts projects institutionalized
established
The private sector Institutionalization of
data is system for gathering
50% of system in
incorporated into health information private
DOH Report 1% place and
the administrative sector for administrative
institutionalized
reporting system of reports
the government

STRATEGIES FOR 2011-2016

Development and promotion of the eHealth agenda


Development, promotion and adoption of critical health application systems , including real time
reporting and recording of health information
Adoption of national data, ICT and relevant eHealth standards
Enhancement and expansion of stakeholder collaboration for both health data producers and users
under the Philippine Health Information System and ICT for Health
Creation of the National Telehealth Services Program
Public-private partnership for eHealth and development and implementation of various systems

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6.3. INTERNAL MANAGEMENT SYSTEMS

6.3.1. Financial Management

Having strong financial management systems is of utmost importance, especially in the health sector. This
ensures that scarce resources are used optimally and that necessary controls are established. Inefficiency and
ineffectiveness adversely affect health outcomes by compromising the delivery of health goods and services,
especially to the countrys most vulnerable groups. Among the crucial processes involved in financial
management are financial planning, budget formulation, budget execution, accounting, financial reporting,
and internal control.

Even though promising systems are already in place, the following limitations continue to impede
effectiveness and efficiency in financial management:

1. Inconsistent implementation of financial processes, procedures, and guidelines at both national and
local levels;
2. Lack of integration of the financial management systems;
3. Lack of a budgeting system that follows medium-term budget planning and prevents resource gaps in
implementing multi-year priority health programs and activities;
4. Poor monitoring and evaluation of financial management;
5. Absence of an efficient information system that links DOH offices and LGUs;
6. Restricted government health budget; and
7. Difficulty in managing a highly decentralized system (NOH 2005, 138-9).

As a response to these limitations, the Public Finance Management Reform Strategy was launched in 2009
with goals of having improved budget credibility, improved budget execution, and improved internal controls
(F1, 1-7).

6.3.1.1. Improved Budget Credibility


A credible budget serves as an instrument that ensures that public resources are delivered reliably and
predictably. Efficiency will be promoted by integrating priority-setting, planning and resource allocation.
Under this objective, the following reform initiatives are highlighted:
1. Development of the Health Sector Expenditure Framework (HSEF), a Medium-Term Expenditure
Framework (MTEF) for the health sector, to better align budget with priority policies
2. Preparation of budgets using DOH Organizational Performance Indicator Framework (OPIF), in
coordination with the Department of Budget and Management (DBM). OPIF is intended to measure
the agencys performance in the implementation of PPAs with emphasis on major final outputs;

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3. Operationalization of the Program Planning and Budget Development Committee (PPBDC), which
improves budget preparation by reinforcing the links between planning and budget.

6.3.1.2. Improved Budget Execution

Improving budget execution entails making reliable information accessible to managers at all levels in the
DOH for enhanced monitoring and evaluation. This enables early detection of problems so that necessary
corrective measures may be taken before the situation gets out-of-hand. Steps taken to achieve this goal
include:
1. Installation of the Electronic New Government Accounting System (ENGAS), which links CHDs,
DOH hospitals, and the Central Office to form a DOH-wide financial information system. It
ensures the correctness, reliability, completeness and timeliness in recording government
transactions. The new system also generates financial reports, in accordance with generally
accepted accounting principles.
2. Integration of procurement, logistics, and financial management information systems
3. Development of an Executive Information System (EIS) and Finance Tracking Module through a
DOH Public Expenditure Tracking System (ETS), which is interfaced with the integrated
procurement, logistics, and financial management system that is used for the regular reporting of
actual expenditure against the budget listed by PPA.

6.3.1.3. Improved Internal Controls

Improving internal controls involves establishing and maintaining a network of systems to ensure effective
operations; economic and efficient use of resources; compliance with policies, procedures, laws, and
regulations; safeguarding of assets and interests from losses; and integral and reliable information. Significant
strides under this goal include the following reforms:
1. Operationalization of a Monitoring Unit within the Financial and Management Service
2. Use of scorecards and other monitoring tools to measure outputs and outcomes
3. Development of the Financial Management Services Operations Manual and Internal Audit
Manual
4. Upgrading the Internal Audit Division into the Internal Audit Service, a move to implement the
shift from the traditional to a risk-based and process-focused approach towards internal audit
5. Preparation of a DOH risk identification and control matrix as part of the Risk Management
Program
6. Operationalization of a Property Management Unit under the Administrative Service
7. Development of an Asset Management System in the Central Office, CHDs, and DOH hospitals
8. DOH-wide implementation of National Guidelines on Internal Control Systems (NGICS)

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9. Use of e-banking facilities to improve the efficiency of operations, such as fund transfers and
ATM payroll systems
10. Setting up of the Anti-Graft Initiative as a system of control that aims to minimize corrupt
practices, enforce penalties and sanctions, and establish a system of accountability and transparency
for those who are entrusted with government resources.
Cutting across all these proposed reforms are the key concepts of collaboration, integration, and enhanced
monitoring and evaluation. It is of utmost importance that stakeholders work together during the planning
and appropriation phases priorities must be identified and addressed, resources must be allocated
appropriately (i.e., prevent underestimation and overestimation). Moreover, systems must be utilized
optimally and integrated to ensure that financial information flows across agencies, thereby promoting
transparency, accountability, and enhanced decision-making. Integrated systems also pave the way for better
monitoring and evaluation.

6.3.2. Procurement Management


The DOH has invested in management and training systems to support the implementation of reforms
relating to procurement procedures and the delivery of health services. Additional checks and balances,
particularly in the form of monitoring and evaluation, are advisable to assess and document the impact of
these tools on the DOHs capacity to manage and allocate health expenditures.
Challenges previously identified that hamper the efficient administration of limited health resources remain
largely exigent. Examples of these include: (1) Inconsistent implementation of procurement processes,
procedures, and guidelines at national and local levels despite the development of management tools and
training programs. (2) Inadequate coordination of activities between the various offices overseeing
procurement. (3) Delays in procurement processes due to lack of unified standards in terms of product
specifications as well as required documents on the end user side. (4) Limited consultation regarding desired
services and lack of participation among firms and individuals resulting in bid failures.

To address some of these challenges, the Philippine government is overseeing the following interventions:
(a) Implementation of Republic Act 9184, or the Government Procurement Reform Act. Through
institutionalized procurement planning functions and a procurement monitoring system in Centers for
Health Development and DOH hospitals, the law seeks to lower procurement costs, generate
substantial savings, and ensure that goods and services are available at service delivery points.
(b) Pilot testing of the Government Procurement Policy Boards Agency Procurement Compliance
and Performance Indicators (GPPB-APCPI). The GPPB-APCPI is a system for monitoring
compliance in the implementation of revised IRRs in CHDs and DOH hospitals.
(c.) Procurement Operations and Management Information System (POMIS) became operational in
June 2010 with the main function of tracking documents and activities. POMIS serves as a system to

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integrate and standardize the information flow between the centralized offices responsible for
procurement operations and management.

6.3.3. Logistics Management


In spite of the continuing development of the processes and procedures, many challenges continue to hamper
the efficient and effective administration of limited health resources. These include:
1) Inconsistent implementation of logistics processes, procedures and guidelines at national, regional
(CHDs) and local levels;
2) Lack of integration between financial, procurement and logistics management systems;
3) Inadequate skills on the management of logistics systems at the central, regional (CHDs) and local
levels and
4) Poor monitoring and evaluation of logistics management (Department of Health 2005).

In the past years, improvements in the logistics department had been made in terms of employees skills
training, space maximization, and development of guidelines. The next five (5) years will address the issues of
implementation process, integration between and among departments, infrastructures, and human resource
requirements.

Training health workers is essential to improve quality assurance encompassing proper storage practices and
good manufacturing practices. This is in line with the Republic Act No. 9184 an act providing for the
modernization, standardization and regulation of procurement activities of the government.
Another problem encountered is the manual processes of doing inventory. The lag time between updating
and reporting is a major issue leading to discrepancies between stock card count and physical count.
Therefore to address this, computerization of logistics processes and inventory is well under way. Not only
will it provide transparency of the processes and information on deliveries, but it will also strengthen other
activities of the drug management cycle, such as forecasting and procurement; and serve as a medium to
enhance financial data recording.

Last but not least, monitoring and evaluation procedures are needed to determine baseline data. From this,
interventions can be assessed in terms of their outcomes which projects to terminate and which ones to
develop further.

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NATIONAL OBJECTIVES FOR 2011-2016
OVERALL GOAL: Ensure the efficiency and effectiveness of financial, procurement and
logistics management systems to support health program implementation.

Strategic
Indicator Data Source Baseline Data 2016 Targets
Objective
% Budget utilization based DOH Financial
76 (2010) 100
on planned targets Report
Financial, Number of budget DOH Financial
20 (2010) 2
procurement and augmentation requests Report
logistics % Procurement request DOH Procurement
management processed out of the total Service Report 60 (2010) 95
performance are requests received
improved % Regions with no stocks DOH
To be
retained in the warehouse Administrative 100
determined
for more than 3 months Service Report
Number of days to release DOH Finance To be
To be determined
funding requests Service Report determined
Number of calendar days to DOH Procurement
Transaction time process goods procurement Service Report 80-120 (2010) 40-60
is reduced request
Number of days to issue the DOH
goods from receipt of Administrative 15 days (2010) 5 days
request Service Report

STRATEGIES FOR 2011-2016

Improve budget credibility, budget execution and internal controls


Develop and institutionalize a strong monitoring and evaluation to ensure the smooth interaction of
the management organization framework components namely, human resources, training, logistics,
and relevant systems and tools
Multi-level audit of current financial management tools and systems to establish a baseline for the
development of comprehensive training workshops to build the capacity of health professionals on
both national and local levels to manage finances and logistics in support of health sector goals,
Advance role of procurement as a partnership in order to improve integration and cooperation
between offices as well as increase support from suppliers and end users,
Develop a standardized records keeping system to improve transparency of procurement and
warehouse storage systems, including inventory tracking tools and system to measure lead times and
potential for spoiled program commodities.
Establish infrastructures for logistics management like air conditioners and handling units such as
pallet trucks, weighing scales, carts, pallets, among others in the region and provinces
Conduct trainings for supply officers and health workers on good practices for the proper handling
and storage of medicines and supplies.
Computerize logistics processes for more efficient information management and immediate roll out
to the LGUs

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IMPLEMENTATION ARRANGEMENT FOR KALUSUGAN
PANGKALAHATAN

To address the call of universal health care (UHC) or Kalusugan Pangkalahatan (KP), the government is
organizing and maximizing all possible resources, and coordinating with partners to respond to this call.
Partner institutions include those that have the machinery to reach most of the target population.
The Department of Health (DOH) shall spearhead the implementation of KP in several phases from 2011 to
2016 with the support of the Local Government Units (LGUs), other national agencies, development
partners, civil society organizations, non-government organizations and other stakeholders.
Individuals and families who are beneficiaries of KP are encouraged to assert their rights and entitlements for
quality health care services and facilities and cooperate in the implementation of health programs, projects
and activities.

The investment of the government for the health sector shall be complemented by development partners. It
is expected that development partners shall align and harmonize their support to the thrusts and directions of
KP. Development partners can fill health investment gaps and assist the DOH and LGUs in capacity
building, policy and research development and systems strengthening.
Coordination mechanisms shall be put in place to ensure that health partners and stakeholders are well
consulted and properly informed on policy directions as well as in program and project development and
implementation towards the attainment of KP.

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7.1. KP PERFORMANCE TARGET

The National Objective for Health performance target from 2011 to 2016 is reflected in Table 35

TABLE 35. KP KEY PERFORMANCE TARGETS

2011 2012 2013 2014 2015 2016

CHTs CHT and RN 50,000 100,000 100,000 100,000 100,000


deployed, Heals as part 12,000 22,500 22,500 22,500 22,500
RNheals/ of the SDN
others developed
deployed to
achieve the
MDGs
Facilities Validation of 1,377 RHUs 471 RHUs 190 District 6 DOH Enhanced
upgraded to health facility 69 District 243 District Hospitals Hospitals provision of
provide upgrading Hospitals Hospital 6 City health services
quality investment 72 Provincial 55 Provincial Hospitals in health
health plans and City and City 33 DOH facilities through
services Hospitals Hospital Hospitals improvement of
8 DOH 22 DOH *Incentives to processes and
Hospitals Hospital sustain delivery systems within
of quality care the health
introduced facilities
Families All NHTS-PR All NHTS-PR Universal Universal Universal Universal
covered by are enrolled and informal Coverage Coverage Coverage Coverage
PhilHealth and eligible to sector are *Catastrophic
the NHIP. enrolled care package
*catastrophic fully
care package implemented
introduced

To improve financial risk protection, DOH will increase NHIP coverage by sustaining the enrolment of at
least 5.3 M NHTS-PR poor households, with intention to expand to all 10.9 million NHTS-PR households. It
will also improve benefits by implementing a no balance billing policy (i.e. no out of pocket charges) for
members of the NHIP Sponsored Program. Twenty-three of the most common conditions for confinement
are being considered under the scheme for PhilHealth Sponsored Program members admitted in government
hospitals.

To improve access to modern health facilities, DOH will upgrade a total of 2,552 government health facilities
nationwide in order to close the upgrading gap by 2016. The upgrading will make these facilities compliant
with DOH and PhilHealth standards by ensuring that RHUs meet accreditation, district, provincial and city
hospitals fulfill the licensing and accreditation standards and for DOH facilities to become modern medical

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centers. The upgraded facilities will also be monitored for quality improvements and assisted to attain long
term financial sustainability.

Lastly, KP will implement focused public health services in order to prevent families, especially the poor,
from falling ill or injured. In order to do this, DOH will assist LGUs in deploying 100,000 Community Health
Teams (CHT) and 22,500 RNheals to: engage families and provide information; assist in health risk
assessment and health use plan development; and facilitate use of services and provide basic services (see
Figure 49).

FIGURE 49. KP INTERVENTIONS TO ADDRESS CHALLENGES TO UNIVERSAL HEALTH CARE

It can be expected that by 2016, there is universal PhilHealth coverage, improved access to modern health
facilities and quality services and MDG targets are achieved. These can be expected to improve financial risk
protection, improve access to quality health services, reduce costs, and more importantly, save the lives of
thousands of mothers and children and increase the productivity of future generations of Filipinos.
In particular, poor Filipino families will be aware that they are protected from vulnerabilities since they are:
1. enrolled in the NHIP;
2. assigned to a CHT;
3. linked to designated health facilities and providers that are KP compliant;
4. not charged for use of health services; and
5. provided with free public health services (e.g. vaccinations, TB DOTS, family planning).

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7.2. PHASING OF KP IMPLEMENTATION

The implementation of KP shall be undertaken in three phases namely Launch Phase, Scale-up Phase, and
Sustainability Phase as shown in Figure 50.

FIGURE 50. KP IMPLEMENTATION ROAD MAP

7.2.1. PREPARATORY AND LAUNCH PHASE (JANUARY TO DECEMBER 2011)

The Preparatory and Launch phase shall take place from January to December 2011 and it is expected that by
the end of December 2011, at least the 2.3 million beneficiary families of the DSWD's Pantawid Pamilyang
Pilipino Program (4Ps) are enrolled to the NHIP, provided information and guidance on NHIP benefit
availment, and assigned and navigated to the public health and outpatient (OP) services that provide quality
services with adequate supply of public health commodities and drugs. The 4Ps beneficiaries shall have
access to inpatient services provided by upgraded hospitals with adequate supply of drugs and supplies.

7.2.1.1. The Interventions to be implemented for the KP thrust on financial risk protection:

1. Enrol 4.89 million of the poorest NHTS-PR households, including those who are beneficiaries of the
4Ps, into the NHIP sponsored program;
2. Train 10,000 RNheals nurses as trainers and supervisors to capacitate existing community-level
workers (e.g. BHWs, BNS, Barangay officials) with community health team (CHT) functions;
3. Secure drugs, medicines, and supplies for DOH-retained hospitals serving NHTS-PR families
(including 4Ps beneficiaries) for implementation of the "no balance billing" policy;
4. Consolidate inputs supporting local implementation of KP into one instrument and negotiation
process by which to leverage better health performance from Provinces and Independent Cities
through a system of Province- or City-wide agreement for KP
5. Amend the National Health Insurance Act (RA 7875, as amended) Implementing Rules and
Regulations to define a new sponsored program that provides for a population based national local
premium counterpart scheme that maximizes enrolment of poor families by earmarking national
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subsidies for the NHTS-PR households with LGUs subsidizing both NHTS-poor households and
LGU-identified poor;
6. Establish an NHIP membership services program that shall include, among, others, the provision of
critical NHIP information to families such as their benefits and entitlements, their assigned primary
providers, and the network of hospitals that can provide them inpatient services;
7. Implement a new NHIP Outpatient Benefit Package with No Balance Billing (OPB-NBB), based on
a review of the implementation of PhilHealth Circular No. 40, s, 2000;
8. Implement a new NHIP Inpatient Benefit Package with No Balance Billing (IP-NBB) that draws
from the experience of DOH and PhilHealth in NBB implementation;

7.2.1.2. The interventions for the KP thrust on health facilities enhancement shall include the
following:

1. Upgrade 20 percent of DOH-retained hospitals, 46 percent of provincial hospitals, 46 percent of


district hospitals, and 51 percent of RHUs to ensure that the poorest 5.2M NHTS-PR families shall
have access to better quality inpatient and outpatient care;
2. Procure and distribute treatment packs for hypertension and diabetes to the RHUs for the use of 4Ps
beneficiaries;
3. Develop a clear framework, objective criteria and transparent process in determining the necessity
for providing assistance - a menu of options for the delivery of HFEP assistance, including
mechanisms such as grants, central procurement, budget subsidy, etc.; and
4. Synchronize the procurement and logistics cycle with NG and LG procurement systems

7.2.1.3. The Intervention for the KP thrust on attaining health-related MDGs includes the following:

1. Procure and distribute public health commodities to RHUs serving 4Ps beneficiaries for the
attainment of health-related MDGs; and
2. Develop budget execution plans for each CHD, including operational plans for implementing the
MDG breakthrough strategy in the12 priority areas.

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7.2.2. SCALE-UP PHASE 2012-2013

The Scale-up phase shall take place from January 2012 up to December 2013 with the following
interventions.

7.2.2.1. The Interventions to be implemented for the KP thrust on financial risk protection are as
follows:
1. Roll-out a new sponsored program with full national government premium subsidy to 5.2 million
poorest families listed in the NHTS-PR at PhP 2,400.00 per family.
2. Ensure membership services to NHIP members; and
3. Introduce the new OPB and IP packages with No Balance Billing, including catastrophic care
coverage by 2013.

7.2.2.2. The intervention to be implemented for the KP thrust on Health Facility Enhancement shall
focus on the closure of the upgrading gap for local health facilities and DOH-retained
hospitals so that the 10.8 million poor households in the NHTS-PR shall have access to
improved quality of health services. The health facilities for upgrading in 2012 are listed
below.
1. 25 DOH-retained modern medical centers financed through public private partnerships;
2. 27 provincial hospitals;
3. 118 district hospitals; and
4. 973 RHUs accredited to at least provide the new OPB package.

7.2.2.3. The MDG related interventions to be implemented for the KP thrust include the following:
1. Implement the MDG breakthrough strategy by focusing resources and efforts in the 12 areas
with the highest concentration of NHTS poor, women with unmet need for family planning,
mothers giving birth outside facilities, children not fully immunized, children not given Vitamin
A supplementation, and adults who are TB smear positive; and
2. Mobilize at least 100,000 Community Health Teams (CHTs) to be trained and supervised by
21,070 RNheals nurses.

7.2.3. SUSTAINABILITY PHASE (2014-2016)


The sustainability phase shall take place from January 2014 to December 2016; the execution of KP budgets
shall be done in the context of an expenditure framework that sets milestones for KP implementation, which
include the interventions below.

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7.2.3.1. The Interventions to be implemented for the KP thrust on financial risk protection:
1. Sustain coverage of at least 10.8M NHTS-PR families in the NHIP; and
2. Continue enhancement of the OPB and IP packages with no balance billing.

7.2.3.2. The intervention to be implemented for the KP thrust on Health facility Enhancement shall focus
on the sustained provision of quality care at DOH-retained and local health facilities upgraded
through HFEP.
7.2.3.3. The MDG related interventions to be implemented for the KP thrust shall cover the following:
1. Deploy CHTs and RNheals to serve at least the 10.8 M NHTS-PR families; and
2. Attain health-related MDGs by 2015.
The DOH shall oversee and guide the implementation of the KP implemented via total market approach
with the local government as stewards of health in the provinces and cities. The total market approach shall
ensure that all partners in the local market shall be mobilized from both the public and private sector. The
development partners shall provide technical assistance and continue to support the implementation of the
KP.

7.3. COST OF KP IMPLEMENTATION


The implementation of the KP shall require an estimated cost of PhP512.19B from all funding sources
(DOH, LGU, PHIC, PCSO, development partners and private investments via PPP). The budget shall
include a total of P111.66B for preventive and promotive programs and services, P92.6B for health facility
upgrading,P263.42B for reducing financial risks of health care use (includes PhilHealth premiums and
hospital operations). Additional P44.51B will be required to support policy, regulatory and sectoral
management.
TABLE 36.TOTAL KP REQUIREMENTS IN PHP BILLION (2013-2016)

KP Thrust Cost items 2013 2014 2015 2016 TOTAL

Preventive and promotive


Attaining MDGs 26.33 27.36 28.43 29.54 111.66
programs and services

NHIP premium for primary and


Financial risk hospital care including 12.63 12.63 12.63 12.63 50.51
protection catastrophic care
Hospital operations 50.21 52.17 54.20 56.32 212.91
Health facilities Construction and rehabilitation of
19.42 63.80 5 5 92.60
enhancement health facilities
Policy support,
regulatory and
Regulatory unit operations 10.50 10.91 11.33 11.77 44.51
sectoral
management

Total 119.09 166.25 111.59 115.26 512.19

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7.4. STEWARDS AND PARTNERS FOR THE KP IMPLEMENTATION

7.4.1. THE DEPARTMENT OF HEALTH


The DOH is the steward of the whole health sector. The DOH primary role is to lead the country towards
the attainment of the universal health goals. In order to ensure that the LGU goals are aligned with the
national goals for health, the DOH and its attached agencies shall guide the implementation of Kalusugan
Pangkalahatan in the provinces and cities. This is achieved by providing the LGUs with technical assistance,
developing guidelines and policies.

IMPLEMENTATION ARRANGEMENT FOR KP


The DOH has restructured itself to respond to the implementation of KP and achievement of the KP goals.
The Center for Health Development (CHD) is responsible for meeting the KP performance targets in their
respective provinces and cities and shall provide technical assistance to provinces and cities as they implement
the three KP thrusts. The CHD shall manage the resources and leverage resources with the LGU for
performance with respect to the KP implementation. The CHD shall sustain current efforts in the delivery of
priority public health services throughout the region while applying increased effort in selected
provinces/cities under the MDG breakthrough strategy and monitor the performance of provinces and cities
in the region with respect to KP implementation. The CHD and the DOH ARMM are the stewards at the
regional level. They shall be the key partners in working with the LGUs and other partners at the local level
for the improvement of health outcomes.

The national public health programs should sufficiently complement the expansion of the national health
insurance coverage in order to improve health outcomes, increase financial protection from costs of care and
enhance responsiveness of the health care system. The Technical Clusters based at the Central Office shall
provide technical support to KP implementation. They shall consolidate the national level performance
regarding KP targets on NHIP, Health facilities enhancement and MDGs. These clusters shall consolidate
overall resource requirements to implement KP from all sources, including the General Appropriations Act
(GAA), NHIP, and Foreign Assistance Projects (FAPs) and ensure that the technical assistance capacities,
packages, and tools are available to support the requirements in the implementation of KP. They shall
develop measures and a collection, validation, and reporting scheme for monitoring the performance of KP
implementation and shall also determine national level targets with area, regional and provincial breakdowns
for KP implementation.

Resource mobilization for the KP implementation shall be conducted by the DOH. These shall include
consolidation of the annual budget execution plans; performing timely and regular monitoring of budget
expenditures through the Expenditure Tracking System (ETS); and facilitating the timely release of funds and
delivery of commodities to CHDs. Guidelines shall be developed for the engagement and deployment of
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doctors to the barrios (DTTBs), RNheals nurses, midwives and other personnel in support of KP
implementation.

The CHDs shall be assisted in the operationalization of the new HFEP and a new approach to province-wide
agreements for KP performance and implementation. A new method in validating service delivery outcome
measures shall be developed including, among others, modern family planning (MFP) use, facility based
deliveries, TB case detection and cure and developing a sustainable approach to secure access to essential
lifesaving medicines for NHTS-PR families.

7.4.2. LOCAL GOVERNMENT UNITS (LGUs)


The LGUs are the local market stewards and shall ensure total market approach and mobilization of all
partners for improved health outcomes. The LGUs shall formulate and implement the Province-wide
Investment Plan for Health (PIPH) in the provinces and City-wide Investment Plan for health (CIPH) in the
cities. The PIPH and CIPH shall help the provinces, cities, and municipalities to work as one unified health
system and facilitate the achievement of the health goals and serve as the vehicle for implementing health
reforms at the provincial and city level. In the next six years, the DOH will focus on improving the quality of
the local health information systems in the LGUs and on institutionalizing the system. This includes the
refinement of the LGU scorecard and its data collection and feedback system. Furthermore, analysis of
certain weak and strong provincial areas will be made in order to provide better and more equitable services.

7.4.3. NATIONAL GOVERNMENT AGENCIES (NGAs)

The national agencies with the mandate to reduce poverty and serving the poorest of the poor of this
administration shall be important partners in improving health outcomes. The national agencies with their
own competencies and resources can contribute in the implementation of health sector reforms in the
provinces and cities. The health stewards, the DOH and the LGUs, shall collaborate with the national
agencies that will facilitate the achievement of the goals of KP.

Partnership with the Department of Social Welfare and Development (DSWD) shall primarily be done in
reaching the poor families. The DOH coordinates with the DSWD through the CCT 4Ps program in
reaching the poorest and marginalized sector that have the most needs. Providing the quality services and
reducing financial risk protection shall be in coordination with the DSWD, in determining the poor through
the NHTS. The intervention of deploying Doctors to the Barrio, RNheals, midwives and the CHT shall
ensure that the CCT families will have an assigned health worker that will ensure proper health information
and service provision.

Partnership with the Department of Education (DepEd) shall primarily be for ensuring the good health and
nutrition of school children. Good health and effective education goes hand in hand in health and
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development. School health programs are ideal vehicles to link the health, education and sanitation sectors in
order to achieve better results in poverty reduction, development and good health. The coordination with
DepEd shall be on the integration of simple evidence-based measures into the daily school routine to
improve health in the school such as hand washing, tooth brushing and deworming which are components of
the DepEd Essential Health Care Package.

Partnership with the Department of Interior and Local Government (DILG) shall include coordination with
local government units to ensure total market mobilization for health at the LGU levels in the
implementation of the three thrusts of the KP.

Partnership with the Department of Labor and Employment (DOLE) shall help in ensuring health in the
workplaces, in the families of the employed and in the community where the worksite is provided, and that
with quality care contributes to the KP goals.

Partnership with the National Economic and Development Authority (NEDA) and Department of Finance
(DOF) shall facilitate the mobilization of development partners and other resources in support to the KP
implementation.

Partnership with the Department of Budget and Management (DBM) shall result in resource mobilization in
support to KP implementation and in the effective and efficient execution of the GAA.

7.4.4. DEVELOPMENT PARTNERS


The Development Partners (DP) shall provide official development assistance consistent with the national
thrusts and directions for health. The DPs shall align and harmonize their systems and processes with
government procedures and institutional reform processes and cooperate in the establishment of mechanisms
to track development assistance for the KP and ensure the sustainability and institutionalization of assistance
projects to appropriate agencies and offices.

The Development Partners (DPs) assist the DOH and LGUs through provision of technical assistance and
resources through grants or loans. The collaboration between the DOH, LGUs and development partners is
based on the Sector Development Approach for Health (SDAH). Through the SDAH, the DOH coordinates
with the development partners and the national government to ensure the effective implementation of
programs to improve health outcomes. The DOH, LGUs, and development partners interact through various
institutionalized mechanisms, which allow the implementation of SDAH. The Bureau of International Health
Cooperation (BIHC) coordinates and facilitates efficient and effective implementation of foreign-assisted
projects. The DOH through BIHC has collaborated with the international organizations and development
partners namely: UN Organizations (World Health Organization, United Nations Childrens Fund and
United Nations Population Fund); multilateral agencies (World Bank and Asian Development Bank) and
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bilateral agencies (US Agency for International Development, European Union Delegation, Japan
International Cooperation Agency, Agencia Espaola de Cooperacion International para el Dessarolo,
Australian Aid for International Development) among others.

7.4.5. PRIVATE SECTOR

One major approach in achieving maximum results in the present administration is in public and private
partnerships. The private sector includes professional groups like medical, nurses, midwives and other
paramedical groups, companies and pharmaceutical groups. The private sector is considered an integral part
of the health sector. They are responsible for the production of health goods and services that will be of use
to both health providers and consumers. The private sector guidelines and protocols in the provision of
health services meet the standards set by the government. Public-Private Partnership for health (PPP) is an
agreement between the government and the private sector. They serve as a venue in which the manner of
support needed to achieve the health outcomes desired by the country is discussed. The private sector
contributes to the partnership through the sharing of expertise and knowledge and its resources. PPPs are
most evident at the local level where direct provision of services is implemented. The private sector works
within the stewardship of the public sector. The private sector can be a provider of health services, provider
of human resources, and provider of technical assistance to improve the health systems.

7.4.6. NON-GOVERNMENT ORGANIZATIONS (NGOs) AND PEOPLES ORGANIZATIONS (POs)

NGOs and POs also contribute to the health service delivery through program development, management,
policy advocacy, resource mobilization and local service delivery. They provide enormous support to the
system by reaching underserved areas and extending coverage in high-risk areas. These groups have the
capacity to organize and mobilize communities and can serve as effective advocates of health programs at the
national and local levels, as well as being direct providers of services in areas where government services are
inadequate.

7.4.7. COMMUNITY HEALTH TEAMS (CHTs)


The Community Health Team (CHT) guarantees that every family in the community is periodically visited
and attended by health providers as part of the governments efforts to achieve Kalusugan Pangkalahatan . The
CHT Mobilization teams will do a nationwide door-to-door visit to reach all families, especially the poorest
Filipino households, identified through the DSWDs National Household Targeting System (NHTS). The
CHT Mobilization aims to link these families to health service providers, provide basic preventive/promotive
health services when needed, and deliver key health messages. Health education and information in maternal
and child care, adoption of a healthy lifestyle, and utilization and availing of NHIP benefits are among the key
messages that will be disseminated, not only to NHTS poorest families but to each household in the
community.

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7.4.8. INDIVIDUALS AND FAMILIES
Individuals and families are included as important stakeholders for health since they are the direct
beneficiaries of the KP being implemented. The responsibility of upholding the health of individuals and
families does not solely fall upon the government and health care providers. Instead, the individuals and
families themselves have the responsibility to care for their personal health and maintain healthy
communities. Hence, it is important to involve them in decision-making processes through membership in
health-related groups or structures. The individuals and families are empowered through participation in the
decision-making for their own health care, planning and review of health service delivery, development,
implementation and evaluation of health policies, strategies and programs. This enable effective strategies
for improving health services from the standpoint of clients, providers, and policy makers.

7.5. COORDINATION MECHANISM FOR THE KP


A coordination mechanism to ensure total sector mobilization in attaining the KP goals shall be put in place
at all levels. The public and private sector work together in improving the health outcomes. The private sector
is mobilized with the stewardship of the public sector. Partners from the different sectors are involved in the
resolution of issues and decision-making processes. Through this approach, the various stakeholders
contribute their resources to include time and effort and their knowledge and experiences.

The stewards in promoting health in the Philippines are the Department of Health (DOH) and Local
Government Units (LGUs). DOH and LGUs mobilize and coordinate with the national agencies,
development partners, private sector, professional groups, non-government organizations (NGOs), peoples
organizations (PO), and individuals and families to achieve maximum results of the health reforms.

Coordinating mechanism with the development partners are conducted as follows:

1. Joint Assessment and Planning Initiative (JAPI). This is a multi-sectoral body composed of
representatives from the DOH, other government agencies, international donor partners, and civil
society. The JAPI serves as venue for partners to evaluate progress of reform implementation and
recommend future actions at policy and strategic levels.
2. Joint Appraisal Committee (JAC) is another multi-sectoral body which reviews the national health
reform efforts and the Provincial and City Investment Plans for Health
3. Health Partners Meeting (HPM) is conducted every two months to discuss operational issues or
concerns in the implementation of reforms.
4. Technical Assistance Coordination Team (TACT) guarantees that the technical assistance
provided by the partners is aligned with the sector program. This ensures that the manner of support
given by the partners is complementary and is not duplicated.
5. Technical Coordination Meetings (TCM) ensures the monitoring and evaluation of foreign assisted
projects performance indicators at a regular basis including the monitoring for the implementation
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of strategies and activities under the project. It is in this venue that foreign assisted project and issues
and concerns are also discussed and provided with resolutions together with all implementing
partners.

Partnerships for health shall be performance-based and partners in health align and work together in
achieving the national objectives for health. The monitoring and evaluation framework of DOH shall be
made relevant to the parameters set for the KP. This would enable the DOH to manage and track health
outcomes at the national and local levels. The Local Government Unit Scorecard (LGU Scorecard) shall
measure the overall performance of provinces and their respective LGUs and track health outcomes in the
provinces and cities. The Donor Scorecard shall measure the performance of development partners based on
Sector Development Approach for Health (SDAH). The Performance Governance System scorecards at the
central office, Centers for Health Development and hospitals shall measure the performance of the DOH
Central Office, CHDs and hospitals in their contribution to the overall health outcomes.

All these can be achieved by laying down the necessary building blocks for an effective partnership. First, an
environment that is conducive to collaboration should be fostered. A supportive and nurturing environment
is central to managing and sustaining any partnership. Effective exercise of the leadership and stewardship
role of the DOH is necessary to manage the wide array of stakeholders given the decentralized nature of the
health system. Comprehensive policy frameworks should be supported with clear strategic directions that can
be implemented at various levels. This creates involvement among various stakeholders. Second, institutional
support systems have to be in place. This includes:

1. Systems and operating procedures for program and project management;


2. Financial and logistics management;
3. Sharing of information through updated and relevant information databases;
4. Clear reporting and feedback mechanisms; and
5. Functional monitoring and evaluation systems that would encourage the stakeholders to attain
mutual goals.

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PRIORITY LEGISLATIVE MEASURES
Achieving universal health care for all Filipinos will require the following priority legislation:
1. Amendment of the National Health Insurance Act;
2. Laws for corporate governance of hospitals ;
3. Restructuring of Sin Taxes (Alcohol and Tobacco);
4. Law on Responsible Parenthood; and
5. Amendment of selected laws governing practice of health professionals.

The proposed amendment of the National Health Insurance Act is intended to amend provisions concerning national
and local premium counterpart sharing for the Sponsored Program. The amendment will allow for premiums of the
poorest families to be paid in full by the national government. The amendments will also provide for the inclusion of the
second poorest NHTS-PR families and LGU-identified poor into the Sponsored program through a three-way premium
sharing scheme between the national and local governments and individual families.

On the other hand, specific laws converting public facilities into corporate hospitals will facilitate participation of
individual hospitals into PPP arrangements. These specific laws will provide a corporate nature to the facility, define its
mandate as a government corporation, provide for a governing board and allow the facility to enter into contracts,
mobilize its assets as well as generate, retain and spend revenues to limit budgetary dependence and promote long term
sustainability.

The restructuring of sin taxes for alcohol and tobacco will require an amendment of the existing Sin Tax Law (RA 9334).
The amendments will allow maximizing revenues from sin taxes and making price levels high enough to discourage
cigarette and alcohol consumption. The restructuring is expected to generate some PhP 60B per year, of which a portion
shall be earmarked to finance universal health care investments.

A law on responsible parenthood, otherwise known as the RH Bill, will mandate the provision of modern FP services
nationwide instead of it being an optional service subject to the political preference of government officials and health
providers. The law will ensure explicit and sustained provision of modern FP and related services and effectively shield
the family planning program from the annual uncertainty of the budget process.

Lastly, amending the specific laws governing health professions is intended to allow for flexibilities in the exercise of
specific clinical functions to pave the way for substitution (e.g. Nurses or midwives as physician substitutes for specific
functions) and allow other health professionals to be compensated by PhilHealth for services rendered. In particular, the
flexibilities are needed to expand the reach of critical services such as maternal care especially in underserved areas. For
example, midwives are currently prevented by the Midwifery Act and the Medical Act to administer lifesaving
interventions such as IV therapy (i.e. administration of antibiotics). As a result, midwives who perform these procedures
either need to be supervised by a physician or run the risk of being held legally-liable or not getting reimbursed by
PhilHealth.

An alternative to passing specific pieces of legislation would be to pass a specific law on universal health care itself. This
law on universal health care can be made to contain the specific provisions necessary to achieve the goals of specific
amendments or new legislation as stated above

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